1598031841 NPI number — MS. CANDACE FRANCES BEEN DPM, PAC

Table of content: JEFFREY S FREEMAN D.O. (NPI 1831127091)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598031841 NPI number — MS. CANDACE FRANCES BEEN DPM, PAC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEEN
Provider First Name:
CANDACE
Provider Middle Name:
FRANCES
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
DPM, PAC
Provider Gender Code:
F

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:
1598031841
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/08/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
806 HILBIG RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CONROE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77301-1448
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
936-520-5951
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
806 HILBIG RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CONROE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77301-1448
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
936-520-5951
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2012

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: 213E00000X , with the licence number:  SC004286L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: MA003432L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA08606L , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 53-0196960 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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