Provider Demographics
NPI:1346417342
Name:BEAUMONT NEUROSURGICAL SPINE ASSOCIATES PA
Entity Type:Organization
Organization Name:BEAUMONT NEUROSURGICAL SPINE ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:B
Authorized Official - Last Name:CLARK
Authorized Official - Suffix:III
Authorized Official - Credentials:MD
Authorized Official - Phone:409-899-4999
Mailing Address - Street 1:6025 METROPOLITAN DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2408
Mailing Address - Country:US
Mailing Address - Phone:409-899-4999
Mailing Address - Fax:409-899-3978
Practice Address - Street 1:6025 METROPOLITAN DR
Practice Address - Street 2:SUITE 205
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-2408
Practice Address - Country:US
Practice Address - Phone:409-899-4999
Practice Address - Fax:409-899-3978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-09
Last Update Date:2015-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty