Provider Demographics
NPI:1801830815
Name:BEENKEN, SAMUEL W (MD)
Entity Type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:W
Last Name:BEENKEN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 BONNIEVILLE DR
Mailing Address - Street 2:
Mailing Address - City:CALERA
Mailing Address - State:AL
Mailing Address - Zip Code:35040-3606
Mailing Address - Country:US
Mailing Address - Phone:205-478-7575
Mailing Address - Fax:855-450-0848
Practice Address - Street 1:5510 HIGHWAY 280
Practice Address - Street 2:SUITE 215
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35242-6582
Practice Address - Country:US
Practice Address - Phone:205-624-4325
Practice Address - Fax:205-620-6776
Is Sole Proprietor?:No
Enumeration Date:2006-06-16
Last Update Date:2018-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL15438208D00000X
ALPM.552208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL020016114OtherRAILROAD MEDICARE
AL000082627OtherBLUE CROSS
AL000082627Medicaid
ALE50317OtherVIVA
AL020016114OtherRAILROAD MEDICARE