Provider Demographics
NPI:1295782340
Name:ABELDT GP, LLC
Entity type:Organization
Organization Name:ABELDT GP, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:V
Authorized Official - Last Name:ABELDT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:936-639-2346
Mailing Address - Street 1:200 GASLIGHT BLVD
Mailing Address - Street 2:
Mailing Address - City:LUFKIN
Mailing Address - State:TX
Mailing Address - Zip Code:75904-3166
Mailing Address - Country:US
Mailing Address - Phone:936-639-2346
Mailing Address - Fax:936-639-0886
Practice Address - Street 1:200 GASLIGHT BLVD
Practice Address - Street 2:
Practice Address - City:LUFKIN
Practice Address - State:TX
Practice Address - Zip Code:75904-3166
Practice Address - Country:US
Practice Address - Phone:936-639-2346
Practice Address - Fax:936-639-0886
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336C0004X, 335E00000X
TX041963336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX506658OtherBLUE CROSS & BLUE SHIELD
TX750675OtherBLUE CROSS & BLUE SHIELD
TX015612701Medicaid
TX126841901Medicaid
TX750675OtherBLUE CROSS & BLUE SHIELD