Provider Demographics
NPI:1972606820
Name:BECKFORD AVENUE MEDICAL CENTER PA
Entity Type:Organization
Organization Name:BECKFORD AVENUE MEDICAL CENTER PA
Other - Org Name:BECKFORD WARREN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:E
Authorized Official - Last Name:KENNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:252-257-6213
Mailing Address - Street 1:816 US HWY 158 W SUITE 102
Mailing Address - Street 2:
Mailing Address - City:WARRENTON
Mailing Address - State:NC
Mailing Address - Zip Code:27589
Mailing Address - Country:US
Mailing Address - Phone:252-257-6213
Mailing Address - Fax:252-257-3286
Practice Address - Street 1:816 US HWY 158 W SUITE 102
Practice Address - Street 2:
Practice Address - City:WARRENTON
Practice Address - State:NC
Practice Address - Zip Code:27589
Practice Address - Country:US
Practice Address - Phone:252-257-6213
Practice Address - Fax:252-257-3286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-06
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC23579207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89015AYMedicaid
NC89015AYMedicaid
NC2336015Medicare PIN