Provider Demographics
NPI:1114042967
Name:STEPHEN M. BEENE, MD, APMC
Entity Type:Organization
Organization Name:STEPHEN M. BEENE, MD, APMC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:BEENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-340-6233
Mailing Address - Street 1:1863 AVENUE OF AMERICA
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-4529
Mailing Address - Country:US
Mailing Address - Phone:318-340-6233
Mailing Address - Fax:
Practice Address - Street 1:1863 AVENUE OF AMERICA
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-4529
Practice Address - Country:US
Practice Address - Phone:318-340-6233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA020444174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1931101Medicaid
LA5N985Medicare ID - Type Unspecified
LA1931101Medicaid