Provider Demographics
NPI:1346016243
Name:BEACH MEDICAL X1 LLC
Entity Type:Organization
Organization Name:BEACH MEDICAL X1 LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MGR
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:NAUGHTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:407-502-0073
Mailing Address - Street 1:401 N MILLS AVE STE A
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32803-5735
Mailing Address - Country:US
Mailing Address - Phone:407-502-0073
Mailing Address - Fax:
Practice Address - Street 1:401 N MILLS AVE STE A
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-5735
Practice Address - Country:US
Practice Address - Phone:407-502-0073
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-11-30
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty