Provider Demographics
NPI:1699181784
Name:HEART & LUNG CENTER OF SOUTHEAST TEXAS PA
Entity Type:Organization
Organization Name:HEART & LUNG CENTER OF SOUTHEAST TEXAS PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BABETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILPOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-735-6294
Mailing Address - Street 1:2501 JIMMY JOHNSON BLVD
Mailing Address - Street 2:STE 406
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77640-2013
Mailing Address - Country:US
Mailing Address - Phone:409-548-4761
Mailing Address - Fax:409-729-2129
Practice Address - Street 1:2501 JIMMY JOHNSON BLVD
Practice Address - Street 2:STE 406
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77640-2013
Practice Address - Country:US
Practice Address - Phone:409-548-4761
Practice Address - Fax:409-729-2129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-09
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7264207RC0001X
TN36561207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac ElectrophysiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
H98217Medicare UPIN
3889565Medicare PIN