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NPI Code Detail

MEDICARE: VINCENT LEE BEAM A.T.,C.

MEDICARE: VINCENT LEE BEAM A.T.,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
12255A2300XAthletic Trainer107041MO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1107041OTHERMOATHLETIC TRAINER

General Provider Information

NPI Number : 1497713127
Entity Type Code : Individual
Provider Name (Legal Business Name) : VINCENT LEE BEAM A.T.,C.
Provider Business Mailing Address
First Line : 1480 W 8TH ST
Second Line :
City : WEST PLAINS
State : MO
Zip : 65775-2010
Country : US
Telephone Number : 417-256-5669
Fax Number : 417-256-5699
Provider Business Practice Location Address
First Line : 1480 W 8TH ST
Second Line :
City : WEST PLAINS
State : MO
Zip : 65775-2010
Country : US
Telephone Number : 417-256-5669
Fax Number : 417-256-5699
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/02/2006
Last Update Date : 07/08/2007

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Directions to “ VINCENT LEE BEAM A.T.,C.” Practice Location

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