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DSH450346Q BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL (Active)
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Main Details
Name
BAPTIST HOSPITALS OF SOUTHEAST TEXAS DBA BAPTIST BEAUMONT HOSPITAL
Subdivision Name
Jasper Outpatient Infusion - Outpatient Infusion Clinic
Type
Disproportionate Share Hospital
Rural
No
340B ID
DSH450346Q
Medicare Provider Number
450346
Outpatient Facility Provider Number
Additional Details
Current Program Status
Active
Registration Date
1/11/2024
Participating Start Date
4/1/2024
Participating Approval Date
3/6/2024
Last Recertification Date
8/21/2024
Contacts
Authorizing Official
Baptist Hospitals of Southeast Texas
Bryan Chandler, Chief Operations Officer
(409) 212-5004
Primary Contact
Baptist Hospitals of Southeast Texas
Aily Powell, Administrative Director of Pharmacy
(409) 212-7282
Addresses
Street Address
1440 FM 777
Jasper, TX 75951
Billing Address
Baptist Hospitals of Southeast Texas
P.O. Box 1591
Beaumont, TX 77704
Comments
Medicaid Billing
Shipping Addresses
Contract Pharmacies
Parent/Child
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