MEDICARE: JOSEPH A BEARDSLEY MD PROFESSIONAL CORP

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	174400000X	Specialist	01031707A	IN

General Provider Information

NPI Number	:	1114265238
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOSEPH A BEARDSLEY MD PROFESSIONAL CORP

Provider Business Mailing Address
First Line	:	1777 W STONES CROSSING RD STE 1
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7899
Country	:	US
Telephone Number	:	317-346-5480
Fax Number	:

Provider Business Practice Location Address
First Line	:	1777 W STONES CROSSING RD STE 1
Second Line	:
City	:	GREENWOOD
State	:	IN
Zip	:	46143-7899
Country	:	US
Telephone Number	:	317-346-5480
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JOSEPH A BEARDLSEY
Credential	:	M.D.
Telephone Number	:	317-346-5480

Provider Enumeration Date	:	01/24/2013
Last Update Date	:	01/24/2013

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