Kenneth T Bedock, PA

Primary specialty

Surgical Physician AssistantTaxonomy code 363AS0400X

License

649 Issued in TN

Practice address

1220 Trotwood Ave
Suite 401
Columbia, TN 38401-6433

Phone

(931) 388-6550

Fax

(931) 388-6459

NPI assigned

Mar 27, 2009

Last updated

Mar 27, 2009By 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 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• East Tennessee Cardiovascular Surgery Group, P.C

  • Contractor
  • Knoxville, TN
  • NPI 1679525448
  NPD (past)

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

{
    "created_epoch": "1238112000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1238112000000",
    "number": "1780826461",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "854 W JAMES CAMPBELL BLVD",
            "address_2": "SUITE 303A",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384014659",
            "telephone_number": "931-540-4255",
            "fax_number": "931-490-4654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1220 TROTWOOD AVE",
            "address_2": "SUITE 401",
            "city": "COLUMBIA",
            "state": "TN",
            "postal_code": "384016433",
            "telephone_number": "931-388-6550",
            "fax_number": "931-388-6459"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BEDOCK",
        "first_name": "KENNETH",
        "middle_name": "T",
        "credential": "PA",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2009-03-27",
        "last_updated": "2009-03-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "TN",
            "license": "649",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Beck Dental Care
• David Brian Beck, FNP, NP-C
• Lillian Beck
• Victor Clarence Beck Jr., DDS
• Beckman Family Chiropractic
• Bee Bright Therapies PLLC
• Brett Begley
• Behavioral Healthcare Center at Columbia, LLC
• Elizabeth Bellamy, FNP-C
• Chris Beloud

• Surgical Physician Assistant in Columbia, TN
• Providers in Columbia, TN by specialty
• Surgical Physician Assistant in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2009; 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.