Basic Information
| Provider Information | |||||||||
| NPI: | 1578748489 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TRI-MET MEDICAL SERVICES, PA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3406 COLLEGE | ||||||||
| Address2: | SUITE 00 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098131677 | ||||||||
| FaxNumber: | 4098131699 | ||||||||
| Practice Location | |||||||||
| Address1: | 3406 COLLEGE | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777014691 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4098131677 | ||||||||
| FaxNumber: | 4098131699 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2008 | ||||||||
| LastUpdateDate: | 05/14/2013 | ||||||||
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| AuthorizedOfficialLastName: | STOUT | ||||||||
| AuthorizedOfficialFirstName: | KEITH | ||||||||
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| AuthorizedOfficialTitleorPosition: | FAMILY PRACTIONER | ||||||||
| AuthorizedOfficialTelephone: | 4098131677 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 146M00000X | E9428 | TX | Y | 193200000X MULTI-SPECIALTY GROUP | Emergency Medical Service Providers | Emergency Medical Technician, Intermediate |
No ID Information.