MEDICARE: BEACOM FAMILY HEALTH CONNECTION, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	21469	NE

General Provider Information

NPI Number	:	1003119108
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEACOM FAMILY HEALTH CONNECTION, LLC

Provider Business Mailing Address
First Line	:	1625 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5463
Country	:	US
Telephone Number	:	402-721-8830
Fax Number	:	402-721-8840

Provider Business Practice Location Address
First Line	:	1625 E MILITARY AVE
Second Line	:
City	:	FREMONT
State	:	NE
Zip	:	68025-5463
Country	:	US
Telephone Number	:	402-721-8830
Fax Number	:	402-721-8840

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	SUSAN SCHLECHT
Credential	:
Telephone Number	:	402-721-8830

Provider Enumeration Date	:	12/10/2010
Last Update Date	:	10/24/2022

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