Provider Demographics
NPI:1598998627
Name:BEAUMONT CHRONIC PAIN LLC
Entity Type:Organization
Organization Name:BEAUMONT CHRONIC PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:Q A
Authorized Official - Last Name:WEBB
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:409-924-8600
Mailing Address - Street 1:5220 EASTEX FWY
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77708-5320
Mailing Address - Country:US
Mailing Address - Phone:409-924-8600
Mailing Address - Fax:409-924-8611
Practice Address - Street 1:5220 EASTEX FWY
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77708-5320
Practice Address - Country:US
Practice Address - Phone:409-924-8600
Practice Address - Fax:409-924-8611
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-24
Last Update Date:2009-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXMDE3137174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX7772517OtherAETNA
TX1241770OtherUNITED HEALTHCARE
TX8AM940OtherBLUECROSS BLUESHIELD
TX8F6505Medicare PIN