Provider Demographics
NPI:1659941078
Name:BEACH MEDICAL PLLC
Entity Type:Organization
Organization Name:BEACH MEDICAL PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ZOE
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHERMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:252-207-8784
Mailing Address - Street 1:PO BOX 2287
Mailing Address - Street 2:
Mailing Address - City:KITTY HAWK
Mailing Address - State:NC
Mailing Address - Zip Code:27949-2287
Mailing Address - Country:US
Mailing Address - Phone:252-261-4187
Mailing Address - Fax:833-989-2346
Practice Address - Street 1:5200 N CROATAN HWY STE 6
Practice Address - Street 2:
Practice Address - City:KITTY HAWK
Practice Address - State:NC
Practice Address - Zip Code:27949-3990
Practice Address - Country:US
Practice Address - Phone:252-261-4187
Practice Address - Fax:833-989-2346
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-28
Last Update Date:2023-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care