Paul Bryan Beachem IV, ATC

Primary specialty

Athletic TrainerTaxonomy code 2255A2300X

License

9067793-4810 Issued in UT

Practice address

7400 Old Main Hill
Dale Mildenberger Sports Medicine Complex
Logan, UT 84322

Phone

(435) 797-3636

NPI assigned

Mar 3, 2016

Last updated

Mar 3, 2016By the provider in NPPES

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1456963200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1456963200000",
    "number": "1043670011",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7400 OLD MAIN HILL",
            "address_2": "DALE MILDENBERGER SPORTS MEDICINE COMPLEX",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "84322"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7400 OLD MAIN HILL",
            "address_2": "DALE MILDENBERGER SPORTS MEDICINE COMPLEX",
            "city": "LOGAN",
            "state": "UT",
            "postal_code": "84322",
            "telephone_number": "435-797-3636"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEACHEM",
        "first_name": "PAUL",
        "middle_name": "BRYAN",
        "name_prefix": "Mr.",
        "name_suffix": "IV",
        "credential": "ATC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-03-03",
        "last_updated": "2016-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "UT",
            "license": "9067793-4810",
            "primary": true
        },
        {
            "code": "2255A2300X",
            "taxonomy_group": "",
            "desc": "Specialist/Technologist, Athletic Trainer",
            "state": "PA",
            "license": "RTO000189",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Niquelle Baxter
• Kindra Gayle Sealy Bean, LCSW
• Bear River Association of Governments
• Bear River Association of Governments
• Bear River Association of Governments
• Bear River District Health Department (Bear River Behavioral Health Clinical Lab)

• Athletic Trainer in Logan, UT
• Providers in Logan, UT by specialty
• Athletic Trainer in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 3, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.