MEDICARE: RUBY S BESHEARS

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	335E00000X	Prosthetic/Orthotic Supplier

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0437Q	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1982689105
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	RUBY S BESHEARS

Provider Business Mailing Address
First Line	:	3030 GREENHOUSE ROAD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-7206
Country	:	US
Telephone Number	:	336-784-0803
Fax Number	:

Provider Business Practice Location Address
First Line	:	3030 GREENHOUSE RD
Second Line	:
City	:	WINSTON SALEM
State	:	NC
Zip	:	27127-7206
Country	:	US
Telephone Number	:	336-784-0803
Fax Number	:

Authorized Official
Title or Position	:	OWNER CONSULTANT
Name	:	RUBY S BESHEARS
Credential	:
Telephone Number	:	336-784-0803

Provider Enumeration Date	:	12/09/2005
Last Update Date	:	07/11/2008

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Directions to “RUBY S BESHEARS ” Practice Location

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