NPIMap

Organization Active NPI

Southeast Texas Ear, Nose & Throat, LLP

  • Otolaryngology Physician
  • Beaumont, TX
National Provider Identifier
1962477406
Registry record updated Oct 5, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Otolaryngology PhysicianTaxonomy code 207Y00000X
Legal business name
SOUTHEAST TEXAS EAR, NOSE & THROAT, LLP
Practice address
740 Hospital Dr
Suite 300
Beaumont, TX 77701-4666
Phone
(409) 212-8111
Fax
(409) 981-1787
NPI assigned
Feb 20, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 5, 2020

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

Authorized official

Name
Dr. Carl Carey Jordan, M.D.NPI 1982679452
Title
Physician
Phone
(409) 212-8111

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Otolaryngology PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207Y00000X Primary

Addresses

Primary practice location

740 Hospital Dr
Suite 300
Beaumont, TX 77701-4666

Mailing address

740 Hospital Dr
Suite 300
Beaumont, TX 77701-4666
Phone (409) 212-8111

Other identifiers 1

IdentifierTypeStateIssuer
084884801MedicaidTX

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in TX

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20060208000093 TX Part B Supplier - Clinic/Group Practice 8426063736 Receives reassigned benefits from 18 practitioners
Practice locations: Beaumont, TX

National Provider Directory

National Provider Directory

Locations

3030 North St
#520
Beaumont, TX 77702
Phone (409) 892-6401

740 Hospital Dr
Ste 310
Beaumont, TX 77701
Phone (409) 981-1700

740 Hospital Dr
Ste 300
Beaumont, TX 77701
Phone (409) 212-8111

Practitioners & affiliated clinicians

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

View all 18

NPI Registry JSON

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

{
    "created_epoch": "1140393600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1601856000000",
    "number": "1962477406",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "740 HOSPITAL DR",
            "address_2": "SUITE 300",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014666",
            "telephone_number": "409-212-8111",
            "fax_number": "409-981-1787"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "740 HOSPITAL DR",
            "address_2": "SUITE 300",
            "city": "BEAUMONT",
            "state": "TX",
            "postal_code": "777014666",
            "telephone_number": "409-212-8111",
            "fax_number": "409-981-1787"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEAST TEXAS EAR, NOSE & THROAT, LLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-02-20",
        "last_updated": "2020-10-05",
        "certification_date": "2020-10-05",
        "status": "A",
        "authorized_official_last_name": "JORDAN",
        "authorized_official_first_name": "CARL",
        "authorized_official_middle_name": "CAREY",
        "authorized_official_title_or_position": "PHYSICIAN",
        "authorized_official_telephone_number": "409-212-8111",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "207Y00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Otolaryngology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "084884801",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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 Oct 5, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.