Beaumont Nephrology Associates
Organization Active NPI Nephrology Physician · Jasper, TX
NPI 1710157722 · NPPES record last updated Jun 4, 2010
Key facts
- NPI
- 1710157722
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Nephrology Physician 207RN0300X
- Legal business name
- BEAUMONT NEPHROLOGY ASSOCIATES
- Practice address
- 930 Marvin Hancock Dr
Room a
Jasper, TX 75951-4752 - Phone
- (409) 212-9240
- Fax
- (409) 212-9239
- NPI assigned
- Mar 5, 2008
- Organization subpart
- No
Authorized official
- Name
- Dr. Jose Lozano, MD
- Title
- President
- Phone
- (409) 212-9240
Other NPIs on the same Medicare enrollment 1
Practitioners 5
-
Ajith Kuriakose, MD
-
Elias N Ezike, MD
-
Mary Manuel, MD
-
Timi A Akins, MD
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in TX
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20051026000086 | TX | Part B Supplier - Clinic/Group Practice | 0648297093 |
Receives reassigned benefits from 1 practitioner 1 other NPI on this enrollment This NPI is an additional NPI on the enrollment Practice locations: Beaumont, TX; Jasper, TX |
National Provider Directory
Locations
3150 Medical Center Dr
Ste 3
Beaumont, TX 77701
Phone (409) 212-9240
930 Marvin Hancock Dr
Jasper, TX 75951
Phone (409) 384-4200
930 Marvin Hancock Dr
Rm A
Jasper, TX 75951
Phone (409) 212-9240
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nephrology Physician |
207RN0300X | Yes |
Addresses
Primary practice location
930 Marvin Hancock Dr
Room a
Jasper, TX 75951-4752
Mailing address
2955 Harrison St
#100
Beaumont, TX 77702-1154
Phone (409) 212-9240
Other providers in Jasper, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 4, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.