Provision Imaging of Beaumont

Primary specialty

Radiology Clinic/CenterTaxonomy code 261QR0200X

License

R28589 Issued in TX

Legal business name

PROVISION IMAGING OF BEAUMONT

Practice address

3980 Dowlen Rd
Beaumont, TX 77706-6847

Phone

(409) 898-1922

Fax

(409) 898-1920

NPI assigned

Jul 26, 2006

Organization subpart

No

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

Authorized official

Name

Robert Matt Trent

Title

Coo

Phone

(405) 842-7768

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1153872000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1821012907",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1601 NW EXPRESSWAY",
            "address_2": "SUITE 1300",
            "city": "OKLAHOMA CITY",
            "state": "OK",
            "postal_code": "73118",
            "telephone_number": "405-842-7768",
            "fax_number": "405-842-7789"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3980 DOWLEN RD",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777066847",
            "telephone_number": "409-898-1922",
            "fax_number": "409-898-1920"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PROVISION IMAGING OF BEAUMONT",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-07-26",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "TRENT",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "MATT",
        "authorized_official_title_or_position": "COO",
        "authorized_official_telephone_number": "405-842-7768"
    },
    "taxonomies": [
        {
            "code": "261QR0200X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Radiology",
            "state": "TX",
            "license": "R28589",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Private Hospital Group LLP
• Jay C. Proctor III, MD
• Corey Lynn Proenza
• Pronto Medical Services
• Prosthetic Solution Centers of America, LLC (Prosthetic Solution Center)
• Provisionam (ProvisioAm, LLC)
• Joseph W Provo III, DDS
• Brazhona Prudhomme
• Stacy Lynn Pruitt, RD, LD
• Gita Chetty Pulley, O. D.

• Radiology Clinic/Center in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Radiology Clinic/Center 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.