Provider Demographics
NPI:1497703946
Name:KAREN BROUSSARD
Entity Type:Organization
Organization Name:KAREN BROUSSARD
Other - Org Name:BELTWAY MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEANNA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:713-974-1176
Mailing Address - Street 1:10645 RICHMOND AVE
Mailing Address - Street 2:SUITE 160
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77042-4923
Mailing Address - Country:US
Mailing Address - Phone:713-974-1176
Mailing Address - Fax:713-783-2679
Practice Address - Street 1:10645 RICHMOND AVE
Practice Address - Street 2:SUITE 160
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77042-4923
Practice Address - Country:US
Practice Address - Phone:713-974-1176
Practice Address - Fax:713-783-2679
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-05
Last Update Date:2008-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0080639332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
5426160001Medicare NSC