Provider Demographics
NPI:1821093170
Name:BEAMER, WILSON C (MD)
Entity type:Individual
Prefix:
First Name:WILSON
Middle Name:C
Last Name:BEAMER
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 1:1027 ALTAMONT RD
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29609-6203
Mailing Address - Country:US
Mailing Address - Phone:865-705-3526
Mailing Address - Fax:
Practice Address - Street 1:1027 ALTAMONT RD
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29609-6203
Practice Address - Country:US
Practice Address - Phone:865-705-3526
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-14
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36290207LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207LC0200XAllopathic & Osteopathic PhysiciansAnesthesiologyCritical Care Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN100010198OtherPHP TENNCARE
TN2002578OtherBLUE CROSS
TN2002578OtherBLUECARE
TN050011295OtherUHC MEDICARE
TN3081811Medicaid
TN2002578OtherBLUECARE
TN100010198OtherPHP TENNCARE