Provider Demographics
NPI:1124467881
Name:BEACH MEDICAL SPECIALISTS LLC
Entity type:Organization
Organization Name:BEACH MEDICAL SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:G
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-773-9898
Mailing Address - Street 1:2033 S PATRICK DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:INDIAN HARBOUR BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-4418
Mailing Address - Country:US
Mailing Address - Phone:321-773-9898
Mailing Address - Fax:321-773-3354
Practice Address - Street 1:2033 S PATRICK DR
Practice Address - Street 2:SUITE B
Practice Address - City:INDIAN HARBOUR BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-4418
Practice Address - Country:US
Practice Address - Phone:321-773-9898
Practice Address - Fax:321-773-3354
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty