Southen Tranquility Medispa, Inc.

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

License

101911 Issued in NC

Legal business name

SOUTHEN TRANQUILITY MEDISPA, INC.

Practice address

130 Cardinal Dr
Roanoke Rapids, NC 27870-4946

Phone

(252) 365-4440

Fax

(252) 308-0862

NPI assigned

Apr 16, 2015

Last updated

Apr 16, 2015By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Mr. Carlton Reid Beaman Jr., PA-CNPI 1093713117

Title

Medical Director/Owner

Phone

(252) 308-0686

Specialties & licenses 1

Addresses

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Carlton Reid Beaman Jr., PA-C

  • Physician Assistant
  • Roanoke Rapids, NC
  • NPI 1093713117
  Authorized official Same address or phone

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

{
    "created_epoch": "1429142400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1429142400000",
    "number": "1417344433",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "130 CARDINAL DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "27870",
            "telephone_number": "252-365-4440",
            "fax_number": "252-308-0862"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "130 CARDINAL DR",
            "city": "ROANOKE RAPIDS",
            "state": "NC",
            "postal_code": "278704946",
            "telephone_number": "252-365-4440",
            "fax_number": "252-308-0862"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SOUTHEN TRANQUILITY MEDISPA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-04-16",
        "last_updated": "2015-04-16",
        "status": "A",
        "authorized_official_last_name": "BEAMAN",
        "authorized_official_first_name": "CARLTON",
        "authorized_official_middle_name": "REID",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR/OWNER",
        "authorized_official_telephone_number": "252-308-0686",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_name_suffix": "Jr.",
        "authorized_official_credential": "PA-C"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": "NC",
            "license": "101911",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Harris Jesse Smith, PA-C
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• Michael Dean Sorensen, M.D.
• Spears Pharmacy Inc (Spears Pharmacy)
• Larry O'Neal Spears, RPH.
• Jeanne Spence, DDS
• Genevieve Spiliopoulos, MS
• Spring Life Behavioral Care LLC

• Clinic/Center in Roanoke Rapids, NC
• Providers in Roanoke Rapids, NC by specialty
• Clinic/Center in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 16, 2015; 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.