Healthcare Provider Details

I. General information

NPI: 1972606820
Provider Name (Legal Business Name): BECKFORD AVENUE MEDICAL CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 05/08/2024
Certification Date: 04/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

816 US HWY 158 W SUITE 102
WARRENTON NC
27589
US

IV. Provider business mailing address

816 US HWY 158 W SUITE 102
WARRENTON NC
27589
US

V. Phone/Fax

Practice location:
  • Phone: 252-257-6213
  • Fax: 252-257-3286
Mailing address:
  • Phone: 252-257-6213
  • Fax: 252-257-3286

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number23579
License Number StateNC

VIII. Authorized Official

Name: JAMES E KENNEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 252-257-6213