MR. THEO JOSEPH BEACH JR. (NPI# 1710533286) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1710533286 |
| Entity Type | Individual |
| Full Name | MR. THEO JOSEPH BEACH JR. |
| Credential | PA-C |
| Practice Address |
3186 Village Dr Ste 201 Fayetteville NC 28304-3979 |
| Practice Telephone | 9104865700 |
| Practice Fax Number | 9104865950 |
| Mailing Telephone | 9104865700 |
| Enumeration Date | 2019-08-12 |
| Last Update Date | 2019-09-11 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2085R0204X |
Radiology Specialization: Vascular & Interventional Radiology |
0010-09318 | NC | Allopathic & Osteopathic Physicians |
| Y | 363A00000X | Physician Assistant | 0010-09318 | NC | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
3186 VILLAGE DR STE 201 |
| City | FAYETTEVILLE |
| State | NC |
| Zip Code | 28304-3979 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275536815 | David J. Allison | Radiology | 3186 Village Dr Ste 201, Fayetteville, NC 28304-3979 | 2005-05-27 |
| 1013357904 | Bryan Nicholas Swilley | Radiology | 3186 Village Dr Ste 201, Fayetteville, NC 28304-3979 | 2013-06-25 |
| 1982943908 | Guirguis Eskandar | Radiology | 3186 Village Dr Ste 201, Fayetteville, NC 28304-3979 | 2013-02-11 |
| 1487919502 | Prasad B Patel | Radiology | 3186 Village Dr Ste 201, Fayetteville, NC 28304-3979 | 2012-07-05 |
| 1104142512 | Pratish Ajay Shah | Radiology | 3186 Village Dr Ste 201, Fayetteville, NC 28304-3979 | 2010-04-09 |
| 1093723538 | Valley Radiology, Pa | Radiology | 3186 Village Dr Ste 201, Fayetteville, NC 28304-3979 | 2006-08-03 |
| 1053392084 | Gretchen Elizabeth Green | Radiology | 3186 Village Dr Ste 201, Fayetteville, NC 28304-3979 | 2005-11-08 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598301061 | Coast To Coast Bilingual Counseling | Social Worker | 910 Hope Mills Road, Fayetteville, NC 28304 | 2019-11-20 |
| 1811530561 | Frances L. Hurst | Technician | 6732 Carloway Dr, Fayetteville, NC 28304 | 2019-10-25 |
| 1538717764 | Rose Mary A O'conner | Technician | 3530 Madison Ave, Fayetteville, NC 28304 | 2019-08-30 |
| 1932756087 | Sally Frances Jones | Technician | 2053 Mango Circle, Fayetteville, NC 28304 | 2019-08-23 |
| 1326528803 | Jeneen Yvette Townsend | Counselor | 2671 Adams Lake Dr Apt F, Fayetteville, NC 28304 | 2018-08-15 |
| 1780179580 | Ma Cornelia Villavicencio Leano | Nurse Practitioner | 3081 Stone Carriage Cir Apt Z, Fayetteville, NC 28304 | 2018-06-25 |
| 1861986267 | Pediatric After Hours Care of Fayetteville | Pediatrics | 556 Sandhurst Drive, Fayetteville, NC 28304 | 2018-06-19 |
| 1700386133 | Good Night Medical of Ohio, LLC | Durable Medical Equipment & Medical Supplies | 405 Owen Dr Ste 202, Fayetteville, NC 28304 | 2018-02-12 |
| 1003321365 | Valleygate Dental Surgery Center of Fayetteville, LLC | Dentist | 2038 Litho Place, Fayetteville, NC 28304 | 2017-12-08 |
| 1871004663 | The Salt Project | Marriage & Family Therapist | 1611-b Owen Dr., Fayetteville, NC 28304 | 2017-10-19 |
| Find all providers in zip 28304 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1306443387 | Melissa Macneil Spencer | Physician Assistant | 810 Knighthood Cir, Fayetteville, NY 13066-8721 | 2020-10-03 |
| 1366067548 | Prathna Raval | Physician Assistant | 6808 Thames Dr, Fayetteville, NC 28306-2524 | 2020-06-12 |
| 1205465895 | Gillian Vaughan Heard | Physician Assistant | 1275 Ga-54 #201, Fayetteville, GA 30214 | 2020-04-06 |
| 1144858515 | Mackenzie Anna Kirchner | Physician Assistant | 568 Sandy Creek Rd, Fayetteville, GA 30214-4205 | 2020-03-31 |
| 1770116931 | Chasity Nicole Sullivan | Physician Assistant | 202b Highland Ave, Fayetteville, NC 28305-5308 | 2020-02-17 |
| 1740812833 | Madeline Everitt Monday | Physician Assistant | 705 Stonington Dr, Fayetteville, NC 28311-0329 | 2020-02-07 |
| 1396375325 | Lisa Ann Gross | Physician Assistant | 3007 Town Center Dr Ste 100, Fayetteville, NC 28306-3663 | 2020-01-17 |
| 1811536048 | Kelly Hamilton Sweatt | Physician Assistant | 1991 Fordham Dr Ste 200, Fayetteville, NC 28304-3774 | 2020-01-06 |
| 1922563667 | Reandy Nicole Hearn | Physician Assistant | 2911 Breezewood Ave Ste 100, Fayetteville, NC 28303-5464 | 2019-02-06 |
| 1790259430 | Cassandra Ann Nebosky-diaz | Physician Assistant | 659 Daharan Dr, Fayetteville, NC 28314-6538 | 2019-01-16 |
| Find all providers in FAYETTEVILLE | ||||
| City | FAYETTEVILLE |
| Zip Code | 28304 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.