MEDICARE: DR. S ADDISON BEESON DO

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	207P00000X	Emergency Medicine Physician	3105	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	P00300534	OTHER	OK	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407835655
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. S ADDISON BEESON DO

Provider Business Mailing Address
First Line	:	PO BOX 25277
Second Line	:
City	:	OVERLAND PARK
State	:	KS
Zip	:	66225-5277
Country	:	US
Telephone Number	:	918-307-6920
Fax Number	:	918-307-6951

Provider Business Practice Location Address
First Line	:	10501 E 91ST ST
Second Line	:	STE ED
City	:	TULSA
State	:	OK
Zip	:	74133-5790
Country	:	US
Telephone Number	:	918-307-6920
Fax Number	:	918-307-6951

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

Provider Enumeration Date	:	01/15/2006
Last Update Date	:	06/20/2018

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Directions to “ DR. S ADDISON BEESON DO” Practice Location

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