Provider Demographics
NPI:1265971691
Name:BAPTIST HOSPITAL OF SOUTHEAST TEXAS
Entity type:Organization
Organization Name:BAPTIST HOSPITAL OF SOUTHEAST TEXAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASST. DIRECTOR OF BUSINESS SERVICES
Authorized Official - Prefix:MRS
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:
Authorized Official - Last Name:FANCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-212-6087
Mailing Address - Street 1:3080 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-4606
Mailing Address - Country:US
Mailing Address - Phone:409-212-6087
Mailing Address - Fax:409-212-6104
Practice Address - Street 1:3080 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-4606
Practice Address - Country:US
Practice Address - Phone:409-212-6087
Practice Address - Fax:409-212-6104
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX000389282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1731242Medicaid
TX094148601Medicaid
TX094148602Medicaid
TX45S346Medicare UPIN
TX450346Medicare UPIN
TX45T346Medicare UPIN