MEDICARE: JAMES R BEAN APA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1008159	OTHER		NCCPA

General Provider Information

NPI Number	:	1104862788
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES R BEAN APA-C

Provider Business Mailing Address
First Line	:	1013 DUNRAVEN CT
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29527-3154
Country	:	US
Telephone Number	:	843-438-4876
Fax Number	:

Provider Business Practice Location Address
First Line	:	1013 DUNRAVEN CT
Second Line	:
City	:	CONWAY
State	:	SC
Zip	:	29527-3154
Country	:	US
Telephone Number	:	843-438-4876
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2006
Last Update Date	:	11/24/2012

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