MEDICARE: JOYCE WAGNER BEECH PAC

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	363AM0700X	Medical Physician Assistant	000100618	NC

General Provider Information

NPI Number	:	1376528067
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JOYCE WAGNER BEECH PAC

Provider Business Mailing Address
First Line	:	4515 PREMIER DR
Second Line	:	SUITE 204
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8357
Country	:	US
Telephone Number	:	336-802-2075
Fax Number	:	336-802-2076

Provider Business Practice Location Address
First Line	:	4515 PREMIER DR
Second Line	:	SUITE 204
City	:	HIGH POINT
State	:	NC
Zip	:	27265-8357
Country	:	US
Telephone Number	:	336-802-2075
Fax Number	:	336-802-2076

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

Provider Enumeration Date	:	12/14/2005
Last Update Date	:	03/26/2013

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