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NPI Code Detail

MEDICARE: KENNETH T BEDOCK PA

MEDICARE: KENNETH T BEDOCK PA
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
1363AS0400XSurgical Physician Assistant649TN

General Provider Information

NPI Number : 1780826461
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH T BEDOCK PA
Provider Business Mailing Address
First Line : 854 W JAMES CAMPBELL BLVD
Second Line : SUITE 303A
City : COLUMBIA
State : TN
Zip : 38401-4659
Country : US
Telephone Number : 931-540-4255
Fax Number : 931-490-4654
Provider Business Practice Location Address
First Line : 1220 TROTWOOD AVE
Second Line : SUITE 401
City : COLUMBIA
State : TN
Zip : 38401-6433
Country : US
Telephone Number : 931-388-6550
Fax Number : 931-388-6459
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/27/2009
Last Update Date : 03/27/2009

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Directions to “ KENNETH T BEDOCK PA” Practice Location

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