Active NPI
Brain and Spine Center of Southeast Texas, PLLC
- Neurological Surgery Physician
- Beaumont, TX
National Provider Identifier
1265865158
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Neurological Surgery Physician
- Legal business name
- BRAIN AND SPINE CENTER OF SOUTHEAST TEXAS, PLLC
- Practice address
- 755 S 11TH St Ste 102
Beaumont, TX 77701-3723 - Phone
- (409) 234-7088
- Fax
- (409) 892-8237
- NPI assigned
- Aug 14, 2013
- Organization subpart
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Authorized official
- Name
- Erwin Lo, MD
- Title
- Owner
- Phone
- (409) 234-7088
Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Neurological Surgery Physician | 207T00000X | Primary | ||
| Neurology Physician | 2084N0400X | |||
| Surgical Physician Assistant | 363AS0400X |
Addresses
Primary practice location
755 S 11TH St Ste 102
Beaumont, TX 77701-3723
Mailing address
755 S 11TH St Ste 102
Beaumont, TX 77701-3723
Phone (409) 234-7088
Other practice location 1
204 N 1st St
Conroe, TX 77301-2920
Phone (936) 756-2415
Other practice location 2
111 Vision Park Blvd Ste 245
Shenandoah, TX 77384-3016
Phone (936) 647-0202
Other practice location 3
87 Ih 10 N Ste 221
Beaumont, TX 77707-2562
Phone (409) 554-0545
Other practice location 4
2400 FM 365
Suite 104
Nederland, TX 77627
Phone (409) 554-0545
Other names 1
- SPINE TECH
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20140401000941 | TX | Part B Supplier - Clinic/Group Practice | 4587895727 |
Receives reassigned benefits from 6 practitioners Practice locations: Beaumont, TX; Shenandoah, TX |
National Provider Directory
National Provider DirectoryLocations
27 W Township St
Fayetteville, AR 72703
Phone (479) 480-6677
111 Vision Park Blvd
Ste 245
Shenandoah, TX 77384
Phone (936) 647-0202
Practitioners & affiliated clinicians
Practitioners 6
Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1376438400000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1729036800000",
"number": "1265865158",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "755 S 11TH ST STE 102",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777013723",
"telephone_number": "409-234-7088",
"fax_number": "409-892-8237"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "755 S 11TH ST STE 102",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777013723",
"telephone_number": "409-234-7088",
"fax_number": "409-892-8237"
}
],
"practiceLocations": [
{
"address_1": "204 N 1st St",
"address_purpose": "LOCATION",
"city": "Conroe",
"state": "TX",
"postal_code": "773012920",
"country_code": "US",
"telephone_number": "936-756-2415",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "111 Vision Park Blvd Ste 245",
"address_purpose": "LOCATION",
"city": "Shenandoah",
"state": "TX",
"postal_code": "773843016",
"country_code": "US",
"telephone_number": "936-647-0202",
"fax_number": "409-898-0177",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "87 Ih 10 N Ste 221",
"address_purpose": "LOCATION",
"city": "Beaumont",
"state": "TX",
"postal_code": "777072562",
"country_code": "US",
"telephone_number": "409-554-0545",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "2400 FM 365",
"address_2": "Suite 104",
"address_purpose": "LOCATION",
"city": "Nederland",
"state": "TX",
"postal_code": "77627",
"country_code": "US",
"telephone_number": "409-554-0545",
"fax_number": "844-965-9044",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"organization_name": "BRAIN AND SPINE CENTER OF SOUTHEAST TEXAS, PLLC",
"organizational_subpart": "NO",
"enumeration_date": "2013-08-14",
"last_updated": "2024-10-16",
"certification_date": "2024-10-16",
"status": "A",
"authorized_official_last_name": "LO",
"authorized_official_first_name": "ERWIN",
"authorized_official_title_or_position": "OWNER",
"authorized_official_telephone_number": "409-234-7088",
"authorized_official_credential": "MD"
},
"taxonomies": [
{
"code": "207T00000X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Neurological Surgery",
"state": null,
"license": null,
"primary": true
},
{
"code": "2084N0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Psychiatry & Neurology, Neurology",
"state": null,
"license": null,
"primary": false
},
{
"code": "363AS0400X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Physician Assistant, Surgical",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": [
{
"organization_name": "SPINE TECH",
"code": "3",
"type": "Doing Business As"
}
]
}Other providers in Beaumont, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 16, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.