Healthcare Provider Details

I. General information

NPI: 1255946810
Provider Name (Legal Business Name): BEACON MONITORING PROFESSIONAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/10/2020
Last Update Date: 09/10/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

745 STAFFORDSHIRE RD
FAIRBANKS AK
99709
US

IV. Provider business mailing address

745 STAFFORDSHIRE RD
FAIRBANKS AK
99709
US

V. Phone/Fax

Practice location:
  • Phone: 559-905-2736
  • Fax:
Mailing address:
  • Phone: 559-905-2736
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: DR. BRENT J. TYLER
Title or Position: OWNER
Credential: MD
Phone: 559-905-2736