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NPI Code Detail

MEDICARE: BEACON THERAPEUTIC

MEDICARE: BEACON THERAPEUTIC
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
1251300000XLocal Education Agency (LEA)

General Provider Information

NPI Number : 1700927092
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEACON THERAPEUTIC
Provider Business Mailing Address
First Line : 1912 W 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2625
Country : US
Telephone Number : 773-298-1243
Fax Number : 773-298-1078
Provider Business Practice Location Address
First Line : 1912 W 103RD ST
Second Line :
City : CHICAGO
State : IL
Zip : 60643-2625
Country : US
Telephone Number : 773-298-1243
Fax Number : 773-298-1078
Authorized Official
Title or Position : CFO
Name : MR. DANIEL WASHINGTON
Credential :
Telephone Number : 773-298-1243
Provider Enumeration Date : 02/09/2007
Last Update Date : 08/22/2020

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Directions to “BEACON THERAPEUTIC ” Practice Location

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