Basic Information
| Provider Information | |||||||||
| NPI: | 1003815697 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BEATY | ||||||||
| FirstName: | STEVEN | ||||||||
| MiddleName: | L. | ||||||||
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| Credential: | CRNA | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2344 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462062344 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8668574190 | ||||||||
| FaxNumber: | 8007310751 | ||||||||
| Practice Location | |||||||||
| Address1: | 1994 GALLATIN PIKE N | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | MADISON | ||||||||
| State: | TN | ||||||||
| PostalCode: | 371152026 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6158510001 | ||||||||
| FaxNumber: | 6158510021 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/18/2005 | ||||||||
| LastUpdateDate: | 04/16/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 367500000X | 11406 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Anesthetist, Certified Registered |
ID Information
| ID | Type | State | Issuer | Description | 74000290 | 05 | AL | MEDICAID | 3125002 | 01 | TN | BCBS NUMBER | OTHER | 3624353 | 05 | TN | MEDICAID |