=====================================================
General NPI Number Information
=====================================================
NPI Number | 1285601104
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETAMED, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/01/2006
-----------------------------------------------------
Last Update Date | 11/13/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1802 WELSH AVE
-----------------------------------------------------
City | COLLEGE STATION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77840-4851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-703-1407
-----------------------------------------------------
Fax | 979-703-1403
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1802 WELSH AVE
-----------------------------------------------------
City | COLLEGE STATION
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77840-4851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 979-703-1407
-----------------------------------------------------
Fax | 979-703-1403
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | JOSHUA DAVID SHIELDS
-----------------------------------------------------
Credential | C.P.A.
-----------------------------------------------------
Telephone | 979-703-1407
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number | 0061609
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------