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1669670360

NPI Code Detail

MEDICARE: TIMOTHY BEACHAM MD

MEDICARE: TIMOTHY BEACHAM MD

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	207LP2900X	Pain Medicine (Anesthesiology) Physician	20443	MS
2	207L00000X	Anesthesiology Physician	20443	MS
3	208VP0014X	Interventional Pain Medicine Physician	20443	MS
4	207LP2900X	Pain Medicine (Anesthesiology) Physician	49929	KY

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	302I057501	OTHER	MS	MEDICARE PTAN
4	343174YXV2	OTHER	MO	MEDICARE PTAN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1669670360
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY BEACHAM MD

Provider Business Mailing Address
First Line	:	4201 SPRINGHURST BLVD STE 102
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-6156
Country	:	US
Telephone Number	:	502-515-4902
Fax Number	:

Provider Business Practice Location Address
First Line	:	4201 SPRINGHURST BLVD STE 102
Second Line	:
City	:	LOUISVILLE
State	:	KY
Zip	:	40241-6156
Country	:	US
Telephone Number	:	502-352-2530
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/05/2007
Last Update Date	:	06/17/2024

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Directions to “ TIMOTHY BEACHAM MD” Practice Location

Language	Start Address	Practice Location

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