Organization
PROVISION IMAGING OF BEAUMONT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT MATT TRENT (COO)
(405) 842-7768
Entity
Organization
Contact information
Practice address
3980 DOWLEN RD, BEAUMONT, TX 77706-6847
(409) 898-1922
(409) 898-1920
Mailing address
1601 NW EXPRESSWAY, SUITE 1300, OKLAHOMA CITY, OK 73118
(405) 842-7768
(405) 842-7789
Taxonomy
Speciality
Code
Description
License number
State
261QR0200X
Radiology Clinic/Center
Primary
R28589
TX
Other
Enumeration date
07/26/2006
Last updated
08/22/2020
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