Healthcare Provider Details

I. General information

NPI: 1851218796
Provider Name (Legal Business Name): JOHN T BEEMER CPSW
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/01/2026
Last Update Date: 07/01/2026
Certification Date: 07/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4841 TRAMWAY RIDGE DR NE
ALBUQUERQUE NM
87111-2787
US

IV. Provider business mailing address

12021 SKYLINE RD NE APT 2401
ALBUQUERQUE NM
87123-2885
US

V. Phone/Fax

Practice location:
  • Phone: 505-388-2361
  • Fax: 888-636-7582
Mailing address:
  • Phone: 505-401-7913
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number2079
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: