Provider Demographics
NPI:1891064200
Name:SMITHA E OOMMEN MD PLLC
Entity type:Organization
Organization Name:SMITHA E OOMMEN MD PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SMITHA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:OOMMEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-212-5967
Mailing Address - Street 1:3560 DELAWARE ST STE 1104
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77706-3000
Mailing Address - Country:US
Mailing Address - Phone:409-347-8870
Mailing Address - Fax:409-554-0016
Practice Address - Street 1:3560 DELAWARE ST STE 1104
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77706-3000
Practice Address - Country:US
Practice Address - Phone:409-347-8870
Practice Address - Fax:409-554-0016
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-14
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXN7853207R00000X, 207RX0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RX0202XAllopathic & Osteopathic PhysiciansInternal MedicineMedical OncologyGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty