Provider Demographics
NPI:1841213006
Name:JOHN L BEAN DO INC
Entity Type:Organization
Organization Name:JOHN L BEAN DO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:LOUIS
Authorized Official - Last Name:BEAN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-781-7511
Mailing Address - Street 1:1132 W KANSAS ST
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:MO
Mailing Address - Zip Code:64068
Mailing Address - Country:US
Mailing Address - Phone:816-781-7511
Mailing Address - Fax:816-781-3881
Practice Address - Street 1:1132 W KANSAS ST
Practice Address - Street 2:
Practice Address - City:LIBERTY
Practice Address - State:MO
Practice Address - Zip Code:64068
Practice Address - Country:US
Practice Address - Phone:816-781-7511
Practice Address - Fax:816-781-3881
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6851207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
05004031OtherBLUE CROSS BLUE SHIELD
0108237OtherUNITED HEALTHCARE
D16929Medicare UPIN
0108237OtherUNITED HEALTHCARE