Southeast Texas Medical Inc.

Primary specialty

Durable Medical Equipment & Medical SuppliesTaxonomy code 332B00000X

License

0034444 Issued in TX

Legal business name

SOUTHEAST TEXAS MEDICAL INC.

Doing business as

Liberty Medical Mart

Practice address

2818B N Main St
Liberty, TX 77575-3911

Phone

(936) 336-8101

Fax

(936) 336-7152

NPI assigned

May 31, 2005

Organization subpart

No

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

Authorized official

Name

Mrs. Judy Fontenot

Title

President

Phone

(936) 336-8101

Specialties & licenses 1

Addresses

Other names 1

• Liberty Medical Mart Doing business as

Locations

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

{
    "created_epoch": "1117497600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1730182049",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 10126",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775757626",
            "telephone_number": "936-336-8101",
            "fax_number": "936-336-7152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2818B N MAIN ST",
            "city": "LIBERTY",
            "state": "TX",
            "postal_code": "775753911",
            "telephone_number": "936-336-8101",
            "fax_number": "936-336-7152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST TEXAS MEDICAL INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2005-05-31",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "FONTENOT",
        "authorized_official_first_name": "JUDY",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "936-336-8101",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "332B00000X",
            "taxonomy_group": "",
            "desc": "Durable Medical Equipment & Medical Supplies",
            "state": "TX",
            "license": "0034444",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Liberty Medical Mart",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

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• Durable Medical Equipment & Medical Supplies in Liberty, TX
• Providers in Liberty, TX by specialty
• Durable Medical Equipment & Medical Supplies in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.