1205867561 NPI number — DR. JAMES KEVIN BECKMEN D.O.

Table of content: DR. JAMES KEVIN BECKMEN D.O. (NPI 1205867561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205867561 NPI number — DR. JAMES KEVIN BECKMEN D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKMEN
Provider First Name:
JAMES
Provider Middle Name:
KEVIN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205867561
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/22/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 62106
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SANTA BARBARA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
93160-2106
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
805-681-1761
Provider Business Mailing Address Fax Number:
805-681-1768

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2027 VILLAGE LN STE 102
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SOLVANG
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93463-2271
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-688-3440
Provider Business Practice Location Address Fax Number:
805-681-1768
Provider Enumeration Date:
07/05/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  20A7527 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00AX75270 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".