Provider Demographics
NPI:1366413809
Name:UBI CARITAS
Entity type:Organization
Organization Name:UBI CARITAS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAUREN
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAHE
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:409-832-1924
Mailing Address - Street 1:4450 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77705-5205
Mailing Address - Country:US
Mailing Address - Phone:409-832-1924
Mailing Address - Fax:409-832-0275
Practice Address - Street 1:4450 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77705-5205
Practice Address - Country:US
Practice Address - Phone:409-832-1924
Practice Address - Fax:409-832-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2012-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111876201Medicaid
TXX32984Medicare UPIN
TX111876201Medicaid