| Southeast Texas Internal Medicine, Pa | |
|
7980 Anchor Dr Bldg. 400 Port Arthur TX 77642-8266 | |
| (409) 729-7030 | |
| (409) 729-7015 |
| Full Name | Southeast Texas Internal Medicine, Pa |
|---|---|
| Speciality | Internal Medicine |
| Location | 7980 Anchor Dr, Port Arthur, Texas |
| Authorized Official Name and Position | Anthony O. Gambrah (ATTENDING PHYSICIAN) |
| Authorized Official Contact | 4097297030 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Southeast Texas Internal Medicine, Pa Po Box 20477 Beaumont TX 77720-0477 Ph: (409) 729-7030 | Southeast Texas Internal Medicine, Pa 7980 Anchor Dr Bldg. 400 Port Arthur TX 77642-8266 Ph: (409) 729-7030 |
| NPI Number | 1730155995 |
|---|---|
| Provider Enumeration Date | 02/27/2006 |
| Last Update Date | 06/23/2010 |
| Medicare PECOS PAC ID | 1355384330 |
|---|---|
| Medicare Enrollment ID | O20050610000102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730155995 | NPI | - | NPPES |
| 143474801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | J9675 (Texas) | Primary |
| Provider Name | Anthony M Gambrah Sampaney |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1891787115 PECOS PAC ID: 5890738884 Enrollment ID: I20050610000121 |
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