Provider Demographics
NPI:1912191750
Name:SOUTHEAST TEXAS MOBILITY
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS MOBILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:DONNELLY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-842-4821
Mailing Address - Street 1:2270 21ST ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-2952
Mailing Address - Country:US
Mailing Address - Phone:409-842-4821
Mailing Address - Fax:
Practice Address - Street 1:1005 LINDBERGH DR
Practice Address - Street 2:STE. F
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-3659
Practice Address - Country:US
Practice Address - Phone:409-842-4821
Practice Address - Fax:409-842-5187
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
No332BN1400XSuppliersDurable Medical Equipment & Medical SuppliesNursing Facility Supplies
No332BP3500XSuppliersDurable Medical Equipment & Medical SuppliesParenteral & Enteral Nutrition