| Mindrestorative Clinic | |
|
4345 Phelan Blvd Ste 103 Beaumont TX 77707-2157 | |
| (409) 333-1344 | |
| (855) 928-0202 |
| Full Name | Mindrestorative Clinic |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 4345 Phelan Blvd Ste 103, Beaumont, Texas |
| Authorized Official Name and Position | Simonpeter Odion Emokpaire (PARTNER) |
| Authorized Official Contact | 4093331344 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mindrestorative Clinic 4345 Phelan Blvd Ste 103 Beaumont TX 77707-2157 Ph: (409) 333-1344 | Mindrestorative Clinic 4345 Phelan Blvd Ste 103 Beaumont TX 77707-2157 Ph: (409) 333-1344 |
| NPI Number | 1215675152 |
|---|---|
| Provider Enumeration Date | 05/20/2022 |
| Last Update Date | 04/18/2024 |
| Certification Date | 04/18/2024 |
| Medicare PECOS PAC ID | 0749652147 |
|---|---|
| Medicare Enrollment ID | O20230213001437 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1215675152 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0800X | Psychiatry & Neurology - Psychiatry | (* (Not Available)) | Primary |
| Provider Name | Misper Etando |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1033752324 PECOS PAC ID: 2466886353 Enrollment ID: I20200721002154 |
| Provider Name | Simonpeter Emokpaire |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1578106217 PECOS PAC ID: 5193197598 Enrollment ID: I20230214000278 |
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