Provider Demographics
NPI:1174639892
Name:BEAUMONT NEPHROLOGY ASSOCIATES
Entity Type:Organization
Organization Name:BEAUMONT NEPHROLOGY ASSOCIATES
Other - Org Name:BEAUMONT NEPHROLOGY ASSOCIATES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-212-9240
Mailing Address - Street 1:710 S 8TH ST STE A
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4680
Mailing Address - Country:US
Mailing Address - Phone:409-212-9240
Mailing Address - Fax:409-212-9239
Practice Address - Street 1:710 S 8TH ST STE A
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4680
Practice Address - Country:US
Practice Address - Phone:409-212-9240
Practice Address - Fax:409-212-9239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-23
Last Update Date:2021-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RN0300XAllopathic & Osteopathic PhysiciansInternal MedicineNephrologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0936379-01Medicaid
TX00PM58Medicare ID - Type Unspecified
TX0936379-01Medicaid