Provider Demographics
NPI:1710233226
Name:FIRST ASCENT MEDICAL OF EAST TEXAS, PA
Entity Type:Organization
Organization Name:FIRST ASCENT MEDICAL OF EAST TEXAS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MUNROE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-455-1071
Mailing Address - Street 1:7950 SILVERLEAF ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77707-3637
Mailing Address - Country:US
Mailing Address - Phone:409-455-1071
Mailing Address - Fax:409-232-0574
Practice Address - Street 1:2830 CALDER ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1809
Practice Address - Country:US
Practice Address - Phone:409-455-1071
Practice Address - Fax:409-232-0574
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-02
Last Update Date:2012-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM7456207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty