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NPI Code Detail

MEDICARE: TEARNEY BEAM

MEDICARE: TEARNEY BEAM
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
1171W00000XContractor
2305S00000XPoint of Service
3247ZC0005XClinical Laboratory Director (Non-physician)2398286NC

General Provider Information

NPI Number : 1912615048
Entity Type Code : Individual
Provider Name (Legal Business Name) : TEARNEY BEAM
Provider Business Mailing Address
First Line : 4413 GAYNELLE DR
Second Line :
City : CHARLOTTE
State : NC
Zip : 28215-5712
Country : US
Telephone Number : 704-287-0926
Fax Number :
Provider Business Practice Location Address
First Line : 1 BUFFALO AVE NW STE 201
Second Line :
City : CONCORD
State : NC
Zip : 28025-4004
Country : US
Telephone Number : 704-287-0926
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/08/2022
Last Update Date : 11/18/2022

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Directions to “ TEARNEY BEAM ” Practice Location

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