Organization
SOUTHEAST TEXAS MEDICAL ASSOCIATES
Active
Other names
Gulf Coast Laboratory Services
Organization subpart
No
Provider details
NPI number
Authorized official
DEBORAH RICKS (ADM ASST CREDENTIALING)
(409) 839-3118
Entity
Organization
Contact information
Practice address
2929 CALDER ST, SUITE 100, BEAUMONT, TX 77702-1845
(409) 833-9797
(409) 839-3174
Mailing address
2929 CALDER ST, SUITE 100, BEAUMONT, TX 77702-1845
(409) 833-9797
(409) 839-3174
Taxonomy
Speciality
Code
Description
License number
State
291U00000X
Clinical Medical Laboratory
Primary
45D0921403
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0847899-02
—
TX
01
—
690009531
RR MEDICARE
TX
Enumeration date
08/23/2005
Last updated
04/11/2019
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