Provider Demographics
NPI:1629404637
Name:BEAUMONT ER PHYSICIANS PLLC
Entity Type:Organization
Organization Name:BEAUMONT ER PHYSICIANS PLLC
Other - Org Name:BEAUMONT ER PHYSICIANS
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:ORSAK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:281-343-9975
Mailing Address - Street 1:12743 CAPRICORN ST STE 400
Mailing Address - Street 2:
Mailing Address - City:STAFFORD
Mailing Address - State:TX
Mailing Address - Zip Code:77477-3996
Mailing Address - Country:US
Mailing Address - Phone:713-343-9651
Mailing Address - Fax:409-515-1121
Practice Address - Street 1:4004 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-4004
Practice Address - Country:US
Practice Address - Phone:713-343-9651
Practice Address - Fax:409-515-1121
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-23
Last Update Date:2015-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Single Specialty
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency CareGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX00567JOtherBLUE CROSS BLUE SHIELD
TX00567JOtherBLUE CROSS BLUE SHIELD