BEAVER MEDICAL GROUP - BANNING EXTENDED CARE
NPI 1881857597
Non-Pharmacy Dispensing Site in Banning, CA

Q: What is Beaver Medical Group LP's NPI number?

The NPI number for Beaver Medical Group LP is 1881857597. It was assigned to this organization in the NPPES registry on July 3, 2008. The provider is doing business as Beaver Medical Group - Banning Extended Care.

Q: What is Beaver Medical Group LP's specialty?

The primary specialty registered for this NPI is Non-Pharmacy Dispensing Site with taxonomy code 332900000X.

Active since July 03, 2008CLIA 05D1065044 · Microscopy

6109 W RAMSEY ST, BANNING, CA 92220(951) 845-0313 Get Directions Write a Review

NPPES record last updated: April 25, 2013. Verified against the NPPES registry weekly; last sync: July 26, 2026.

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About Beaver Medical Group - Banning Extended Care NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

BEAVER MEDICAL GROUP - BANNING EXTENDED CARE (NPI 1881857597) is a healthcare organization registered as a non-pharmacy dispensing site in Banning, California and active in the NPI registry since July 2008. The organization holds a CLIA Microscopy certificate valid through February 19, 2027 and lists Kenny Heine, Vp Of Operations, as its authorized official.

NPPES Registry Identity

NPI1881857597

Entity TypeOrganization

Primary Taxonomy332900000X

Legal Business NameBEAVER MEDICAL GROUP LP

Location Address6109 W RAMSEY STBanning, CA 92220-3051

Mailing Address5626 Oberlin Dr, Suite 110San Diego, CA 92121-1705

Phone(951) 845-0313

Organization SubpartYesParent: Medvantx Inc

Authorized OfficialKenny HeineVp Of Operations · (858) 625-2990

Enumeration DateJuly 3, 2008

Last NPPES UpdateApril 25, 2013

✔ NPI 1881857597 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers

Taxonomy Code332900000X

License✔ Licensed in CA · C51632

Definition

A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

6109 W RAMSEY ST, Banning, CA 92220

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Other Names 1

Doing Business AsBeaver Medical Group - Banning Extended Care

CLIA Laboratory Certificates CMS CLIA

Laboratory certificates issued under the Clinical Laboratory Improvement Amendments (CLIA) program, which sets federal quality standards for human laboratory testing in the United States. There is no official CMS crosswalk between CLIA and NPI numbers; these certificates are associated with this NPI by matching facility names, locations and phone numbers in the CMS CLIA registry.

Certificate for Provider-Performed Microscopy Procedures (PPMP) 05D1065044

Beaver Medical Group L P Banning Primary Care Center · Banning, CA

Active · expires Feb 19, 2027

CLIA Number05D1065044

Laboratory TypeCommunity Clinic

Certificate Effective DateFebruary 20, 2025

Certificate Expiration DateFebruary 19, 2027

Laboratory DirectorDr. Jill R. Cuni

Laboratory Phone(909) 786-0844

Laboratory LocationBeaver Medical Group L P Banning Primary Care Center5957 W Ramsey St, Banning, CA 92220

CLIA data matches this NPI record on: Name

This certificate is issued to a laboratory in which a physician, midlevel practitioner or dentist performs no tests other than the microscopy procedures. This certificate permits the laboratory to also perform waived tests.

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Other Providers at the Same Location NPPES 20

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

MR. JAMES A MATHEY P.A.-C.

Physician Assistant