MEDICARE: BEYOND MEDICAL

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	208D00000X	General Practice Physician

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	:	1902302375
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEYOND MEDICAL

Provider Business Mailing Address
First Line	:	460 E ALTAMONTE DR STE 2250
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4652
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	460 E ALTAMONTE DR STE 2250
Second Line	:
City	:	ALTAMONTE SPRINGS
State	:	FL
Zip	:	32701-4652
Country	:	US
Telephone Number	:	407-261-1001
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	DANIELLE CLARKE
Credential	:
Telephone Number	:	732-742-4142

Provider Enumeration Date	:	04/03/2018
Last Update Date	:	04/03/2018

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Directions to “BEYOND MEDICAL ” Practice Location

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