Provider Demographics
NPI:1518013614
Name:HUGH P BABINEAU M D P A
Entity Type:Organization
Organization Name:HUGH P BABINEAU M D P A
Other - Org Name:TYLER BARIATRICS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:BABINEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:903-593-0230
Mailing Address - Street 1:1100 E LAKE ST
Mailing Address - Street 2:SUITE 230
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75701-3343
Mailing Address - Country:US
Mailing Address - Phone:903-593-0230
Mailing Address - Fax:903-597-3015
Practice Address - Street 1:1100 E LAKE ST
Practice Address - Street 2:SUITE 230
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-3343
Practice Address - Country:US
Practice Address - Phone:903-593-0230
Practice Address - Fax:903-597-3015
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-25
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX208600000X
363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1486250-01Medicaid
TX0017MQOtherBCBS GROUPP ID#
TX00Y577Medicare PIN
TX0017MQOtherBCBS GROUPP ID#