Provider Demographics
NPI:1477986891
Name:SOUTHEAST TEXAS INPATIENT PHYSICIAN ASSOCIATES
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS INPATIENT PHYSICIAN ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:K
Authorized Official - Last Name:BADLISSI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-722-1197
Mailing Address - Street 1:2400 HIGHWAY 365 STE 205
Mailing Address - Street 2:
Mailing Address - City:NEDERLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77627-6250
Mailing Address - Country:US
Mailing Address - Phone:409-722-1197
Mailing Address - Fax:
Practice Address - Street 1:2555 JIMMY JOHNSON BLVD
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2007
Practice Address - Country:US
Practice Address - Phone:409-724-7389
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-21
Last Update Date:2013-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN0620208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalistGroup - Single Specialty