1124111380 NPI number — LEWIS HENRY BEAZLIE III RN, CNP, BC, CARN-AP

Table of content: LEWIS HENRY BEAZLIE III RN, CNP, BC, CARN-AP (NPI 1124111380)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124111380 NPI number — LEWIS HENRY BEAZLIE III RN, CNP, BC, CARN-AP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEAZLIE
Provider First Name:
LEWIS
Provider Middle Name:
HENRY
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
RN, CNP, BC, CARN-AP
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1124111380
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
588 MEREDITH LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUYAHOGA FALLS
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44223-2591
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
330-926-1662
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10701 EAST BLVD
Provider Second Line Business Practice Location Address:
CVAMC VARC SA(W)
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44106-1702
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
216-791-3800
Provider Business Practice Location Address Fax Number:
216-421-3218
Provider Enumeration Date:
10/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  NP-03858 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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