Organization
THE MEDICAL CENTER OF SOUTHEAST TEXAS LP
Active
Organization subpart
No
Provider details
NPI number
Authorized official
RICHARD D GONZALEZ (HOSPITAL CEO)
(409) 724-7389
Entity
Organization
Contact information
Practice address
2555 JIMMY JOHNSON BLVD, PORT ARTHUR, TX 77640-2007
(409) 724-7389
(409) 853-5917
Mailing address
2555 JIMMY JOHNSON BLVD, ATTN: BILLING, PORT ARTHUR, TX 77640-2007
(409) 724-7389
(409) 853-5910
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
000464
TX
261QC0050X
Critical Access Hospital Clinic/Center
000464
TX
282N00000X
General Acute Care Hospital
Primary
000464
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
163925401
—
TX
05
—
163925402
—
TX
05
—
1731862
—
LA
01
—
HH0567
BLUE CROSS
TX
Enumeration date
02/17/2006
Last updated
04/03/2018
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