Provider Demographics
NPI:1861945511
Name:BEETON PROVIDER SERVICES, INC.
Entity type:Organization
Organization Name:BEETON PROVIDER SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MBA
Authorized Official - Phone:614-529-6562
Mailing Address - Street 1:1566 W 1ST AVE
Mailing Address - Street 2:
Mailing Address - City:GRANDVIEW
Mailing Address - State:OH
Mailing Address - Zip Code:43212-3346
Mailing Address - Country:US
Mailing Address - Phone:614-529-6562
Mailing Address - Fax:614-559-6619
Practice Address - Street 1:1566 W 1ST AVE
Practice Address - Street 2:
Practice Address - City:GRANDVIEW
Practice Address - State:OH
Practice Address - Zip Code:43212-3346
Practice Address - Country:US
Practice Address - Phone:614-529-6562
Practice Address - Fax:614-559-6619
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH2507540253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0187033Medicaid