Provider Demographics
NPI:1518157122
Name:CITY OF PORT ARTHUR
Entity Type:Organization
Organization Name:CITY OF PORT ARTHUR
Other - Org Name:NONE
Other - Org Type:Other Name
Authorized Official - Title/Position:HEALTH AUTHORITY
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:D
Authorized Official - Last Name:GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-983-8832
Mailing Address - Street 1:449 AUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-5802
Mailing Address - Country:US
Mailing Address - Phone:409-983-8800
Mailing Address - Fax:
Practice Address - Street 1:449 AUSTIN AVE
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-5802
Practice Address - Country:US
Practice Address - Phone:409-983-8800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-30
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXZ000F07Y0Medicaid