Organization Active NPI

Brent Mainwaring MD PA

  • Diagnostic Radiology Physician
  • Beaumont, TX
National Provider Identifier
1730467366
Registry record updated Jun 13, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Diagnostic Radiology PhysicianTaxonomy code 2085R0202X
License
H7781 Issued in TX
Legal business name
BRENT MAINWARING MD PA
Doing business as
THE ODC
Practice address
3405 College St
Beaumont, TX 77701
Phone
(409) 832-2211
Fax
(409) 515-1117
NPI assigned
Aug 1, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 13, 2018

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

Authorized official

Name
Dr. Brent Lee Mainwaring, M.D.
Title
M.D.
Phone
(409) 832-2211

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Diagnostic Radiology PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 2085R0202X H7781 TX Primary

Addresses

Primary practice location

3405 College St
Beaumont, TX 77701

Mailing address

3405 College St
Beaumont, TX 77701-4613
Phone (409) 832-2211

Other names 1

  • THE ODC Doing business as

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
45D2292458Brent Mainwaring, MD, PA3405 College St, Beaumont, TX 77701Certificate of waiverOct 24, 2027

National Provider Directory

National Provider Directory

NPI Registry JSON

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

{
    "created_epoch": "1312156800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1528848000000",
    "number": "1730467366",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3405 COLLEGE ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014613",
            "telephone_number": "409-832-2211",
            "fax_number": "409-515-1117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3405 COLLEGE ST",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "77701",
            "telephone_number": "409-832-2211",
            "fax_number": "409-515-1117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRENT MAINWARING MD PA",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-08-01",
        "last_updated": "2018-06-13",
        "status": "A",
        "authorized_official_last_name": "MAINWARING",
        "authorized_official_first_name": "BRENT",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "M.D.",
        "authorized_official_telephone_number": "409-832-2211",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "2085R0202X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Radiology, Diagnostic Radiology",
            "state": "TX",
            "license": "H7781",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "THE ODC",
            "code": "3",
            "type": "Doing Business As"
        },
        {
            "organization_name": "THE ODC",
            "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 Jun 13, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.