Provider Demographics
NPI:1831550680
Name:PAM SQUARED AT BEAUMONT, LLC
Entity type:Organization
Organization Name:PAM SQUARED AT BEAUMONT, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:MISITANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-731-9660
Mailing Address - Street 1:1828 GOOD HOPE RD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:ENOLA
Mailing Address - State:PA
Mailing Address - Zip Code:17025-1233
Mailing Address - Country:US
Mailing Address - Phone:717-731-9660
Mailing Address - Fax:
Practice Address - Street 1:3340 PLAZA 10 DR
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77707-2551
Practice Address - Country:US
Practice Address - Phone:409-835-0835
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-08
Last Update Date:2025-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
No284300000XHospitalsSpecial Hospital
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX367514201Medicaid
453048Medicare Oscar/Certification