Provider Demographics
NPI:1235155102
Name:SOUTHEAST EMERGENCY PHYSICIAN ASSOCIATES, P.A.
Entity Type:Organization
Organization Name:SOUTHEAST EMERGENCY PHYSICIAN ASSOCIATES, P.A.
Other - Org Name:SOUTHEAST EMERGENCY PHYSICIAN ASSOCIATES, P.A.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:HERMANN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERHARDT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:800-258-2016
Mailing Address - Street 1:1120 NASA PKWY
Mailing Address - Street 2:SUITE 205
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77058-3320
Mailing Address - Country:US
Mailing Address - Phone:281-333-1622
Mailing Address - Fax:281-335-8653
Practice Address - Street 1:2830 CALDER STREET
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-3067
Practice Address - Country:US
Practice Address - Phone:281-333-1622
Practice Address - Fax:281-335-8653
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-14
Last Update Date:2007-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX0086AUMedicare ID - Type Unspecified
TX0090AKMedicare ID - Type Unspecified
TX0076BDMedicare ID - Type Unspecified