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General NPI Number Information
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NPI Number | 1073071817
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Entity Type | Organization
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Legal Business Name | BEACON ACCOUNTABLE CARE LLC
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Dates
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Enumeration Date | 03/12/2019
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Last Update Date | 06/11/2019
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Provider Practice Location Address
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Address Line | 4050 ARENDELL ST STE E
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City | MOREHEAD CITY
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State | NC
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Zip | 28557-2940
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Country | US
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Telephone | 252-514-0057
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Fax |
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Provider Business Mailing Address
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Address Line | 4050 ARENDELL ST STE E
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City | MOREHEAD CITY
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State | NC
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Zip | 28557-2940
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Country | US
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Telephone | 252-514-0057
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF OPERATIONS
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Name | MR. BRONNIE JONES JR.
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Credential |
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Telephone | 252-514-0057
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number |
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License Number State |
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