MEDICARE: DR. JOSEPH HERMAN BEAVEN M.D.

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	207R00000X	Internal Medicine Physician	01032564A	IN
2	207P00000X	Emergency Medicine Physician	01032564A	IN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	180443	OTHER	IN	BLACK LUNG

General Provider Information

NPI Number	:	1619963105
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JOSEPH HERMAN BEAVEN M.D.

Provider Business Mailing Address
First Line	:	9431 COUNTY ROAD 403
Second Line	:
City	:	CHARLESTOWN
State	:	IN
Zip	:	47111-8946
Country	:	US
Telephone Number	:	812-256-6391
Fax Number	:	812-256-6050

Provider Business Practice Location Address
First Line	:	9431 COUNTY ROAD 403
Second Line	:
City	:	CHARLESTOWN
State	:	IN
Zip	:	47111-8946
Country	:	US
Telephone Number	:	812-256-6391
Fax Number	:	812-256-6050

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

Provider Enumeration Date	:	09/21/2005
Last Update Date	:	02/21/2022

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