Provider Demographics
NPI:1144465279
Name:LANA S. BEAVERS, MD, LLC
Entity type:Organization
Organization Name:LANA S. BEAVERS, MD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SINGLE MEMBER LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:LANA
Authorized Official - Middle Name:SHARON
Authorized Official - Last Name:BEAVERS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:931-684-8469
Mailing Address - Street 1:885 UNION ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SHELBYVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37160-2607
Mailing Address - Country:US
Mailing Address - Phone:931-684-8469
Mailing Address - Fax:931-684-8472
Practice Address - Street 1:885 UNION ST
Practice Address - Street 2:SUITE A
Practice Address - City:SHELBYVILLE
Practice Address - State:TN
Practice Address - Zip Code:37160-2607
Practice Address - Country:US
Practice Address - Phone:931-684-8469
Practice Address - Fax:931-684-8472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-03
Last Update Date:2008-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNMD0000008506207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNPENDINGOtherMEDICARE PROVIDER NUMBER PENDING