Provider Demographics
NPI:1326221227
Name:BEAMANS WELLNESS CENTER P C
Entity type:Organization
Organization Name:BEAMANS WELLNESS CENTER P C
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:L
Authorized Official - Last Name:BEAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:541-885-9989
Mailing Address - Street 1:1903 AUSTIN ST STE B
Mailing Address - Street 2:
Mailing Address - City:KLAMATH FALLS
Mailing Address - State:OR
Mailing Address - Zip Code:97603-5404
Mailing Address - Country:US
Mailing Address - Phone:541-885-9989
Mailing Address - Fax:541-885-7998
Practice Address - Street 1:1903 AUSTIN ST STE B
Practice Address - Street 2:
Practice Address - City:KLAMATH FALLS
Practice Address - State:OR
Practice Address - Zip Code:97603-5404
Practice Address - Country:US
Practice Address - Phone:541-885-9989
Practice Address - Fax:541-885-7998
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-13
Last Update Date:2008-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD 17645261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORR131505Medicare PIN
ORF21582Medicare UPIN