Basic Information
| Provider Information | |||||||||
| NPI: | 1396701264 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEALS | ||||||||
| FirstName: | DANIEL | ||||||||
| MiddleName: | ALFRED | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1448 10TH AVE STE 304 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 257013579 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046918722 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1600 MEDICAL CENTER DR STE 2500 | ||||||||
| Address2: | |||||||||
| City: | HUNTINGTON | ||||||||
| State: | WV | ||||||||
| PostalCode: | 25701 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3046911200 | ||||||||
| FaxNumber: | 3046911287 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/21/2006 | ||||||||
| LastUpdateDate: | 12/01/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 12/01/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2086S0102X | 15501 | WV | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0102X | 35969 | KY | N | Allopathic & Osteopathic Physicians | Surgery | Surgical Critical Care | 2086S0120X | 15501 | WV | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 2086S0120X | 35969 | KY | N | Allopathic & Osteopathic Physicians | Surgery | Pediatric Surgery | 208600000X | 15501 | WV | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 64011539 | 05 | KY | MEDICAID | 0000000539899 | 01 | KY | ANTHEM | OTHER |