# KENNETT PEDIATRICS AND ADOLESCENTS MEDICINE LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1063414704
- **Authorized official:** ANDREW C BEACH MD (MD OWNER)
- **Authorized official phone:** (573) 888-0001

## Contact information

- **Practice address:** 211 TEACO RD, KENNETT, MO 63857-3236
- **Practice address phone:** (573) 888-0001
- **Practice address fax:** (573) 888-0006
- **Mailing address:** PO BOX 908, KENNETT, MO 63857-0908
- **Mailing address phone:** (573) 888-0001
- **Mailing address fax:** (573) 888-0006

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 208000000X | Pediatrics Physician | — | MO | — |
| 261QR1300X | Rural Health Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 08/12/2005
- **Last updated:** 07/21/2022