NPIMap

Organization Active NPI

Fannett Medical Center

  • Primary Care Clinic/Center
  • Beaumont, TX
National Provider Identifier
1275928673
Registry record updated Apr 2, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
AP127771 Issued in TX
Legal business name
FANNETT MEDICAL CENTER
Practice address
15321 Highway 124
Beaumont, TX 77705-9127
Phone
(409) 794-2314
NPI assigned
Apr 2, 2015
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 2, 2015

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

Authorized official

Name
Dr. Rogelio Mendoza, M.D.
Title
Director/Owner
Phone
(409) 794-2314

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X AP127771 TX Primary

Addresses

Primary practice location

15321 Highway 124
Beaumont, TX 77705-9127

Mailing address

3535 Grayson LN
Beaumont, TX 77713-4158
Phone (409) 201-2994

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 2

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": "1427932800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1427932800000",
    "number": "1275928673",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 GRAYSON LN",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777134158",
            "telephone_number": "409-201-2994"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "15321 HIGHWAY 124",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777059127",
            "telephone_number": "409-794-2314"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FANNETT MEDICAL CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-02",
        "last_updated": "2015-04-02",
        "status": "A",
        "authorized_official_last_name": "MENDOZA",
        "authorized_official_first_name": "ROGELIO",
        "authorized_official_title_or_position": "DIRECTOR/OWNER",
        "authorized_official_telephone_number": "409-794-2314",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "TX",
            "license": "AP127771",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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 Apr 2, 2015; 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.