1851399232 NPI number — STEVEN M BEATTY M.D.

Table of content: STEVEN M BEATTY M.D. (NPI 1851399232)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1851399232 NPI number — STEVEN M BEATTY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEATTY
Provider First Name:
STEVEN
Provider Middle Name:
M
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
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:
1851399232
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/25/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
03/31/2006
NPI Reactivation Date:
05/01/2006

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
513 N MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNA
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
62906-1668
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
618-833-4471
Provider Business Mailing Address Fax Number:
618-833-6267

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
513 N MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ANNA
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
62906-1668
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
618-833-4471
Provider Business Practice Location Address Fax Number:
618-833-6267
Provider Enumeration Date:
07/11/2005

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: 207R00000X , with the licence number:  036-068672 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 110152598 . This is a "UNITED HEALTHCARE RR MEDI" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: C39851 . This is a "CHAMPVA" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 028006 . This is a "HEALTH ALLIANCE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036068672 . This is a "IDPA FEE FOR SERVICE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: C39851 . This is a "TRICARE" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 126592 . This is a "HEALTHLINK" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: C39851 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".
  • Identifier: 036-068672 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00150939 . This is a "RAIL ROAD MEDICARE" identifier . This identifiers is of the category "OTHER".




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