| Glen G.guillet M.d.,p.a. | |
|
5875 N Major Dr Suite 214 Beaumont TX 77713-9013 | |
| (409) 896-5901 | |
| (409) 896-5910 |
| Full Name | Glen G.guillet M.d.,p.a. |
|---|---|
| Speciality | Clinic/Center |
| Location | 5875 N Major Dr, Beaumont, Texas |
| Authorized Official Name and Position | Glen G Guillet (CEO) |
| Authorized Official Contact | 4098965901 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Glen G.guillet M.d.,p.a. 5875 N Major Dr Suite 214 Beaumont TX 77713-9013 Ph: (409) 896-5901 | Glen G.guillet M.d.,p.a. 5875 N Major Dr Suite 214 Beaumont TX 77713-9013 Ph: (409) 896-5901 |
| NPI Number | 1730394545 |
|---|---|
| Provider Enumeration Date | 05/14/2007 |
| Last Update Date | 05/10/2011 |
| Medicare PECOS PAC ID | 5698862951 |
|---|---|
| Medicare Enrollment ID | O20071102000251 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1730394545 | NPI | - | NPPES |
| 0007PM | Other | TX | BCBS |
| 128065306 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QP2300X | Clinic/center - Primary Care | D2455 (Texas) | Primary |
| Provider Name | Glen G Guillet |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1326059577 PECOS PAC ID: 6709835366 Enrollment ID: I20050120000846 |
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