Basic Information
Provider Information
NPI: 1003146184
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BEADLE
FirstName: CLAIRE
MiddleName: LELEUX
NamePrefix: MRS.
NameSuffix:  
Credential: CRNA
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 7703 FLOYD CURL DR
Address2: MC7977
City: SAN ANTONIO
State: TX
PostalCode: 782293901
CountryCode: US
TelephoneNumber: 2104509000
FaxNumber:  
Practice Location
Address1: 4502 MEDICAL DR
Address2:  
City: SAN ANTONIO
State: TX
PostalCode: 782294402
CountryCode: US
TelephoneNumber: 2103584000
FaxNumber: 2103584911
Other Information
ProviderEnumerationDate: 01/12/2010
LastUpdateDate: 11/30/2011
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
367500000X704341TXY Physician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered 

ID Information
IDTypeStateIssuerDescription
P0091159901TXRAILROAD MEDICAREOTHER
21104700205TX MEDICAID
21104700305TX MEDICAID
21104700105TX MEDICAID
8047UA01TXBLUE CROSS BLUE SHIELDOTHER


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