Provider Demographics
NPI:1962477406
Name:SOUTHEAST TEXAS EAR, NOSE & THROAT, LLP
Entity Type:Organization
Organization Name:SOUTHEAST TEXAS EAR, NOSE & THROAT, LLP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:CARL
Authorized Official - Middle Name:CAREY
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-212-8111
Mailing Address - Street 1:740 HOSPITAL DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4666
Mailing Address - Country:US
Mailing Address - Phone:409-212-8111
Mailing Address - Fax:409-981-1787
Practice Address - Street 1:740 HOSPITAL DR
Practice Address - Street 2:SUITE 300
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4666
Practice Address - Country:US
Practice Address - Phone:409-212-8111
Practice Address - Fax:409-981-1787
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-20
Last Update Date:2020-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX084884801Medicaid
TX00R74CMedicare PIN