MEDICARE: JAMES E BEAVER JR. 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	363A00000X	Physician Assistant	779	WV

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

General Provider Information

NPI Number	:	1659364735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMES E BEAVER JR. PAC

Provider Business Mailing Address
First Line	:	208 DOGWOOD CT
Second Line	:
City	:	DANIELS
State	:	WV
Zip	:	25832-9202
Country	:	US
Telephone Number	:	304-763-5121
Fax Number	:	304-469-1518

Provider Business Practice Location Address
First Line	:	134 MEDICAL PL
Second Line	:
City	:	BEAVER
State	:	WV
Zip	:	25813-8977
Country	:	US
Telephone Number	:	304-255-1080
Fax Number	:	304-255-1082

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

Provider Enumeration Date	:	08/24/2005
Last Update Date	:	02/03/2010

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