MEDICARE: KIMBALL AND BEECHER PLLC

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	1223G0001X	General Practice Dentistry

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	002550832	OTHER	IA	UNITED CONCORDIA

General Provider Information

NPI Number	:	1508102153
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KIMBALL AND BEECHER PLLC

Provider Business Mailing Address
First Line	:	3217 CEDAR HEIGHTS DR
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-6039
Country	:	US
Telephone Number	:	319-277-6921
Fax Number	:	319-859-2007

Provider Business Practice Location Address
First Line	:	3217 CEDAR HEIGHTS DR
Second Line	:
City	:	CEDAR FALLS
State	:	IA
Zip	:	50613-6039
Country	:	US
Telephone Number	:	319-277-6921
Fax Number	:	319-859-2007

Authorized Official
Title or Position	:	BILLING MANAGER
Name	:	MRS. MOLLY SPENCE
Credential	:
Telephone Number	:	319-235-6287

Provider Enumeration Date	:	12/28/2012
Last Update Date	:	12/28/2012

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