Healthcare Provider Details

I. General information

NPI: 1982999314
Provider Name (Legal Business Name): STEPHEN KENN BEEMAN M.D., M.P.H., FACS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2011
Last Update Date: 09/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5681 HIGHWAY 363
MANTACHIE MS
38855-7632
US

IV. Provider business mailing address

PO BOX 40
MANTACHIE MS
38855-0040
US

V. Phone/Fax

Practice location:
  • Phone: 662-282-4226
  • Fax: 662-282-7946
Mailing address:
  • Phone: 662-282-4226
  • Fax: 662-282-7946

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number13262
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code2083P0901X
TaxonomyPublic Health & General Preventive Medicine Physician
License Number13262
License Number StateMS
# 3
Primary TaxonomyN
Taxonomy Code208G00000X
TaxonomyThoracic Surgery (Cardiothoracic Vascular Surgery) Physician
License Number13262
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: