Organization
KENNETT PEDIATRICS AND ADOLESCENTS MEDICINE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANDREW C BEACH MD (MD OWNER)
(573) 888-0001
Entity
Organization
Contact information
Practice address
211 TEACO RD, KENNETT, MO 63857-3236
(573) 888-0001
(573) 888-0006
Mailing address
PO BOX 908, KENNETT, MO 63857-0908
(573) 888-0001
(573) 888-0006
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
—
MO
261QR1300X
Rural Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
599371408
—
MO
Enumeration date
08/12/2005
Last updated
07/21/2022
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