Active NPI
Vericare, PC
Doing business as Vericare
- Clinical Psychologist
- Beaumont, TX
National Provider Identifier
1710935119
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- Legal business name
- VERICARE, PC
- Doing business as
- Vericare
- Practice address
- 11025 Voth Rd
Beaumont, TX 77713-8613 - Phone
- (800) 257-8715
- Fax
- (800) 819-1655
- NPI assigned
- May 5, 2006
- Reactivated
- Aug 8, 2007
- Last updated
- Jul 11, 2017
- 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
- Mr. Melissa King
- Title
- Director, Credentialing Enrollment
- Phone
- (800) 370-3651
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | NU | Primary | |
| Clinical Social Worker | 1041C0700X | NU |
Addresses
Primary practice location
11025 Voth Rd
Beaumont, TX 77713-8613
Mailing address
55 Hatchetts Hill Rd
Old Lyme, CT 06371-1534
Phone (800) 370-3651
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 136136212 | Medicaid | TX | |
| CB3582 | Other | TX | RAILROAD MEDICARE |
Other names 1
- Vericare
National Provider Directory
National Provider Directory- Tax ID family
- Vericare
Other organizations with this tax ID 1
Organizations that report the same tax identification number in the National Provider Directory.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1146787200000",
"enumeration_type": "NPI-2",
"last_updated_epoch": "1499731200000",
"number": "1710935119",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "55 HATCHETTS HILL RD",
"city": "OLD LYME",
"state": "CT",
"postal_code": "063711534",
"telephone_number": "800-370-3651",
"fax_number": "877-515-7147"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11025 VOTH RD",
"city": "BEAUMONT",
"state": "TX",
"postal_code": "777138613",
"telephone_number": "800-257-8715",
"fax_number": "800-819-1655"
}
],
"practiceLocations": [],
"basic": {
"organization_name": "VERICARE, PC",
"organizational_subpart": "NO",
"enumeration_date": "2006-05-05",
"last_updated": "2017-07-11",
"deactivation_date": "2007-04-11",
"reactivation_date": "2007-08-08",
"status": "A",
"authorized_official_last_name": "KING",
"authorized_official_first_name": "MELISSA",
"authorized_official_title_or_position": "DIRECTOR, CREDENTIALING ENROLLMENT",
"authorized_official_telephone_number": "800-370-3651",
"authorized_official_name_prefix": "Mr."
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NU",
"license": null,
"primary": true
},
{
"code": "1041C0700X",
"taxonomy_group": "",
"desc": "Social Worker, Clinical",
"state": "NU",
"license": null,
"primary": false
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "136136212",
"state": "TX"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "RAILROAD MEDICARE",
"identifier": "CB3582",
"state": "TX"
}
],
"endpoints": [],
"other_names": [
{
"organization_name": "Vericare",
"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 Jul 11, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.