| Frazier Enterprise Group LLC | |
|
1110 Calder St Ste 106104 Beaumont TX 77701-1777 | |
| (409) 292-8996 | |
| (409) 232-6327 |
| Full Name | Frazier Enterprise Group LLC |
|---|---|
| Speciality | Clinic/Center |
| Location | 1110 Calder St Ste 106104, Beaumont, Texas |
| Authorized Official Name and Position | Lauren Frazier (PRESIDENT) |
| Authorized Official Contact | 2816947574 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Frazier Enterprise Group LLC 6725 Chase Beaumont TX 77708-3752 | Frazier Enterprise Group LLC 1110 Calder St Ste 106104 Beaumont TX 77701-1777 Ph: (409) 292-8996 |
| NPI Number | 1811792161 |
|---|---|
| Provider Enumeration Date | 02/19/2025 |
| Last Update Date | 09/27/2025 |
| Certification Date | 09/27/2025 |
| Medicare PECOS PAC ID | 8527572924 |
|---|---|
| Medicare Enrollment ID | O20250708003592 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1811792161 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | () | Primary |
| 291U00000X | Clinical Medical Laboratory | () | Secondary |
| Provider Name | Kimberli Omwanghe |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1124413596 PECOS PAC ID: 9830407352 Enrollment ID: I20190220001420 |
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