Provider Demographics
NPI:1588318638
Name:JEFFERSON COUNTY PUBLIC HEALTH DEPT
Entity type:Organization
Organization Name:JEFFERSON COUNTY PUBLIC HEALTH DEPT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR/DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:EZEA
Authorized Official - Middle Name:D
Authorized Official - Last Name:EDE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:409-835-8530
Mailing Address - Street 1:1295 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:TX
Mailing Address - Zip Code:77701-3642
Mailing Address - Country:US
Mailing Address - Phone:409-839-2307
Mailing Address - Fax:409-839-2302
Practice Address - Street 1:1295 PEARL ST
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:TX
Practice Address - Zip Code:77701-3642
Practice Address - Country:US
Practice Address - Phone:409-839-2307
Practice Address - Fax:409-839-2302
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-08
Last Update Date:2022-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare