| Beaumont Internal Medicine & Geriatric Assoc. | |
|
755 N 11th St P-5200 Beaumont TX 77702-1501 | |
| (409) 898-2994 | |
| (409) 899-5542 |
| Full Name | Beaumont Internal Medicine & Geriatric Assoc. |
|---|---|
| Speciality | Internal Medicine |
| Location | 755 N 11th St, Beaumont, Texas |
| Authorized Official Name and Position | Santos Marcelo Soberon (PRESIDENT) |
| Authorized Official Contact | 4098982994 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Beaumont Internal Medicine & Geriatric Assoc. 755 N 11th St P-5200 Beaumont TX 77702-1501 Ph: (409) 898-2994 | Beaumont Internal Medicine & Geriatric Assoc. 755 N 11th St P-5200 Beaumont TX 77702-1501 Ph: (409) 898-2994 |
| NPI Number | 1164430906 |
|---|---|
| Provider Enumeration Date | 08/04/2006 |
| Last Update Date | 10/28/2014 |
| Medicare PECOS PAC ID | 9032195789 |
|---|---|
| Medicare Enrollment ID | O20040625000243 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1164430906 | NPI | - | NPPES |
| 093730201 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207RG0300X | Internal Medicine - Geriatric Medicine | (* (Not Available)) | Primary |
| Provider Name | Tara M Holder |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1023160330 PECOS PAC ID: 9133014756 Enrollment ID: I20040223000831 |
| Provider Name | John Terry Fowler |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1528075348 PECOS PAC ID: 3779569421 Enrollment ID: I20040624001631 |
| Provider Name | Alicia H Horn |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1558463562 PECOS PAC ID: 5597702076 Enrollment ID: I20050415000451 |
| Provider Name | Elizabeth M Long |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134156318 PECOS PAC ID: 3476553017 Enrollment ID: I20070105000222 |
| Provider Name | Maria S Blahey |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1053304725 PECOS PAC ID: 7012010762 Enrollment ID: I20070316000415 |
| Provider Name | Chad W Hammett |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1083731756 PECOS PAC ID: 5395825129 Enrollment ID: I20080107000626 |
| Provider Name | Jeremy M Huff |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1982802419 PECOS PAC ID: 8224100227 Enrollment ID: I20080709000027 |
| Provider Name | Waqar Ahmad |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1215077482 PECOS PAC ID: 0941370159 Enrollment ID: I20090430000250 |
| Provider Name | Santos M Soberon |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1275540395 PECOS PAC ID: 2769515865 Enrollment ID: I20100920000874 |
| Provider Name | Mustafa I Musa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1033126164 PECOS PAC ID: 0941333041 Enrollment ID: I20100920000988 |
| Provider Name | Kristen L Blackwell |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144624933 PECOS PAC ID: 4587977251 Enrollment ID: I20150723009137 |
| Provider Name | Lauren Jordan Barrera |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1689076549 PECOS PAC ID: 5890085054 Enrollment ID: I20160601000869 |
| Provider Name | Rawan M Musa |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1205270923 PECOS PAC ID: 8628351988 Enrollment ID: I20170210001033 |
| Provider Name | Stephanie A Williams |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1568816098 PECOS PAC ID: 8325324379 Enrollment ID: I20170406000389 |
| Provider Name | Georgiana Turk Flournoy |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1720537954 PECOS PAC ID: 7517234743 Enrollment ID: I20170518001965 |
| Provider Name | James M Morrison |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1255031985 PECOS PAC ID: 8628431657 Enrollment ID: I20230824000190 |
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