Crystal Beach Medical Clinic LLC

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

CRYSTAL BEACH MEDICAL CLINIC LLC

Practice address

955 S. East Rd.
Crystal Beach, TX 77650-1449

Phone

(409) 454-2543

Fax

(866) 521-5608

NPI assigned

Jul 21, 2006

Last updated

Jan 13, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Bruce Lever Mitchell, PA-C

Title

Member

Phone

(409) 454-2543

Specialties & licenses 1

Addresses

Other identifiers 2

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Jay C. Proctor III, MD

  • Family Medicine Physician
  • Beaumont, TX
  • NPI 1538160726
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1153440000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1231804800000",
    "number": "1114948825",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 1449",
            "city": "CRYSTAL BEACH",
            "state": "TX",
            "postal_code": "776501449",
            "telephone_number": "409-454-2543"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "955 S. EAST RD.",
            "city": "CRYSTAL BEACH",
            "state": "TX",
            "postal_code": "776501449",
            "telephone_number": "409-454-2543",
            "fax_number": "866-521-5608"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CRYSTAL BEACH MEDICAL CLINIC LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-21",
        "last_updated": "2009-01-13",
        "status": "A",
        "authorized_official_last_name": "MITCHELL",
        "authorized_official_first_name": "BRUCE",
        "authorized_official_middle_name": "LEVER",
        "authorized_official_title_or_position": "MEMBER",
        "authorized_official_telephone_number": "409-454-2543",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182389001",
            "state": "TX"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "182389002",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Mary Ellen Bestani, LIC.AC
• Cindy Y Cavazos
• Crystal Beach Volunteer Fire
• Galveston County Emergency Services District -2
• J & J Pharmacy
• Shelly M. Leitch, RN, MSN, CPNP
• Michael F Rodgers, LVN

• Family Medicine Physician in Crystal Beach, TX
• Providers in Crystal Beach, TX by specialty
• Family Medicine Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 13, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.