Organization
BEAUMONT RADIOLOGY GROUP, LLP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. KATHI MANUEL (ADMINISTRATION)
(409) 838-4772
Entity
Organization
Contact information
Practice address
4890 DOWLEN RD, BEAUMONT, TX 77708-4828
(409) 838-4772
(409) 838-6134
Mailing address
4890 DOWLEN RD, BEAUMONT, TX 77708-4828
(409) 838-4772
(409) 838-6134
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00SN29
BLUE CROSS/BLUE SHIELD
TX
05
—
127255101
—
TX
01
—
CP7211
RAILROAD-MEDICARE
TX
Enumeration date
10/17/2006
Last updated
08/20/2009
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