Beaumont Neurosurgical Spine Associates PA

Primary specialty

Neurological Surgery PhysicianTaxonomy code 207T00000X

Legal business name

BEAUMONT NEUROSURGICAL SPINE ASSOCIATES PA

Practice address

6025 Metropolitan Dr
Suite 205
Beaumont, TX 77706-2408

Phone

(409) 899-4999

Fax

(409) 899-3978

NPI assigned

May 9, 2008

Organization subpart

No

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

Authorized official

Name

Dr. Charles B. Clark III, M.D.

Title

Physician

Phone

(409) 899-4999

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1210291200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1425513600000",
    "number": "1346417342",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6025 METROPOLITAN DR",
            "address_2": "SUITE 205",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777062408",
            "telephone_number": "409-899-4999",
            "fax_number": "409-899-3978"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6025 METROPOLITAN DR",
            "address_2": "SUITE 205",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777062408",
            "telephone_number": "409-899-4999",
            "fax_number": "409-899-3978"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BEAUMONT NEUROSURGICAL SPINE ASSOCIATES PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-05-09",
        "last_updated": "2015-03-05",
        "status": "A",
        "authorized_official_last_name": "CLARK",
        "authorized_official_first_name": "CHARLES",
        "authorized_official_middle_name": "B.",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "409-899-4999",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_name_suffix": "III",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207T00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Neurological Surgery",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Neurological Surgery Physician in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Neurological Surgery Physician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 5, 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.