| College Street Medical Group, P.l.l.c. | |
|
5755 College St Beaumont TX 77707-3518 | |
| (409) 840-9300 | |
| (409) 842-4960 |
| Full Name | College Street Medical Group, P.l.l.c. |
|---|---|
| Speciality | Family Medicine |
| Location | 5755 College St, Beaumont, Texas |
| Authorized Official Name and Position | Bodre Rising (PROVIDER/OWNER) |
| Authorized Official Contact | 4098409300 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| College Street Medical Group, P.l.l.c. 5755 College St Beaumont TX 77707-3518 Ph: (409) 840-9300 | College Street Medical Group, P.l.l.c. 5755 College St Beaumont TX 77707-3518 Ph: (409) 840-9300 |
| NPI Number | 1912233289 |
|---|---|
| Provider Enumeration Date | 10/21/2009 |
| Last Update Date | 04/28/2011 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1912233289 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
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