Provider Demographics
NPI:1245361369
Name:SOUTHEAST TEXAS OB GYN ASSOCIATES PA
Entity type:Organization
Organization Name:SOUTHEAST TEXAS OB GYN ASSOCIATES PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MAUREEN
Authorized Official - Middle Name:
Authorized Official - Last Name:MCAULIFFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-899-1499
Mailing Address - Street 1:755 N 11TH ST
Mailing Address - Street 2:STE # P4200
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77702-1501
Mailing Address - Country:US
Mailing Address - Phone:409-899-1499
Mailing Address - Fax:409-899-1354
Practice Address - Street 1:755 N 11TH ST
Practice Address - Street 2:STE # P4200
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77702-1501
Practice Address - Country:US
Practice Address - Phone:409-899-1499
Practice Address - Fax:409-899-1354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-08
Last Update Date:2016-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXCE8392OtherGROUP RAIL ROAD MEDICARE
TX085244401Medicaid
TX45D0959181OtherCLIA
TXT40RMedicare ID - Type Unspecified