Provider Demographics
NPI:1093773418
Name:BEEBE, C T (PA)
Entity Type:Individual
Prefix:
First Name:C
Middle Name:T
Last Name:BEEBE
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:PO BOX 100523
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:SC
Mailing Address - Zip Code:29501-0523
Mailing Address - Country:US
Mailing Address - Phone:843-669-5162
Mailing Address - Fax:843-667-4573
Practice Address - Street 1:4731 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:MURRELLS INLET
Practice Address - State:SC
Practice Address - Zip Code:29576-5090
Practice Address - Country:US
Practice Address - Phone:843-839-7246
Practice Address - Fax:843-839-7323
Is Sole Proprietor?:No
Enumeration Date:2006-05-03
Last Update Date:2021-02-23
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
SCA00716363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC621077OtherSELECT HEALTH
SCP40836Medicare UPIN