Provider Demographics
NPI:1821445099
Name:BEAMER, MATT
Entity Type:Individual
Prefix:
First Name:MATT
Middle Name:
Last Name:BEAMER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3904 S OLD HIGHWAY 94
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-2850
Mailing Address - Country:US
Mailing Address - Phone:314-259-1044
Mailing Address - Fax:
Practice Address - Street 1:2885 TECHNOLOGY DRIVE
Practice Address - Street 2:
Practice Address - City:LAKE ST. LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367
Practice Address - Country:US
Practice Address - Phone:314-259-1044
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-18
Last Update Date:2016-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility