Beene, Jackie

Beene, Jackie is an individual health care provider with primary practice located at 1540 E Evergreen St , Springfield MO 65803-4300. He recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as his primary health care specialty. Beene, Jackie can be contacted via phone (417) 823-2900.

Contact Information

Primary practice address
1540 E Evergreen St Springfield MO 65803-4300
Phone: (417) 823-2900
Fax: (417) 886-2774
Website:
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Health care specialties

SpecialtyCodeLicense #State
Allopathic & Osteopathic Physicians / Family Medicine 207Q00000X R1I02 Missouri

Profile Details

NPI number 1841296548
LBN Legal business name Beene, Jackie
Credentials Doctor of Medicine (MD)
Entity Individual
Sole proprietor 1 No
Enumeration date Jun 27th, 2005
Last updated Jul 28th, 2022 - about 2 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1841296548 NPPES
Other P00065361 RR MEDICARE
MEDICAID 202538732 RR MEDICARE

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