Organization
PROVISIONAM
Active
Other names
ProvisioAm, LLC
Organization subpart
No
Provider details
NPI number
Authorized official
CARLINE PIERRE-LOUIS CENATUS (OWNER)
(239) 404-9870
Entity
Organization
Contact information
Practice address
3819 PHELAN BLVD, BEAUMONT, TX 77707-2243
(409) 363-5022
(409) 363-5015
Mailing address
2280 SUNFLOWER ST, BEAUMONT, TX 77713-9214
(239) 404-9870
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0
WAITING FOR MEDICARE NUMBER
TX
Enumeration date
03/06/2019
Last updated
03/06/2019
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