Provider Demographics
NPI:1578551859
Name:SOUTHEAST TEXAS PULMONARY ASSOCIATES LLP
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS PULMONARY ASSOCIATES LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JOLENE
Authorized Official - Middle Name:
Authorized Official - Last Name:STADEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-896-5000
Mailing Address - Street 1:3030 NORTH ST
Mailing Address - Street 2:STE 510
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1433
Mailing Address - Country:US
Mailing Address - Phone:409-896-5000
Mailing Address - Fax:409-896-5926
Practice Address - Street 1:3030 NORTH ST
Practice Address - Street 2:STE 510
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1433
Practice Address - Country:US
Practice Address - Phone:409-896-5000
Practice Address - Fax:409-896-5926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-11
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095076801Medicaid
TX00U56MMedicare ID - Type Unspecified