Shelby Odell Church Jr., PA-C

Primary specialty

Medical Physician AssistantTaxonomy code 363AM0700X

License

PA01919 Issued in TX

Practice address

6450 Folsom Dr
Beaumont Family Practice Associates
Beaumont, TX 77706-7269

Phone

(409) 835-0524

Fax

(409) 833-2058

NPI assigned

Dec 26, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Southeast Emergency Physician Associates, P.a.

  • Emergency Medicine Physician
  • Beaumont, TX
  • NPI 1235155102
  NPD (past)

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

{
    "created_epoch": "1167091200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1662508800000",
    "number": "1942365564",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6450 FOLSOM DR",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777067269",
            "telephone_number": "409-835-0524",
            "fax_number": "409-835-0632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6450 FOLSOM DR",
            "address_2": "BEAUMONT FAMILY PRACTICE ASSOCIATES",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777067269",
            "telephone_number": "409-835-0524",
            "fax_number": "409-833-2058"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "CHURCH",
        "first_name": "SHELBY",
        "middle_name": "ODELL",
        "name_prefix": "Mr.",
        "name_suffix": "Jr.",
        "credential": "PA-C",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-26",
        "last_updated": "2022-09-07",
        "certification_date": "2022-09-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "TX",
            "license": "PA01919",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Christus Health Southeast Texas
• Christus Trinity Clinic
• Charles R Christy, RN MSN CFNP
• CHS Texas Medical, P.a.
• Nathan Chukwulobe
• Joyce Cialona
• Cima Hospice of Houston, LLC
• Ronald Citrano, DDS
• City of Beaumont
• City of Beaumont Public Health Department

• Medical Physician Assistant in Beaumont, TX
• Providers in Beaumont, TX by specialty
• Medical Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 7, 2022; 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.