1861400731 NPI number — MRS. KAREN A BEIMBORN MEDICINE SURGERY MD

Table of content: MRS. KAREN A BEIMBORN MEDICINE SURGERY MD (NPI 1861400731)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861400731 NPI number — MRS. KAREN A BEIMBORN MEDICINE SURGERY MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEIMBORN
Provider First Name:
KAREN
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MEDICINE SURGERY MD
Provider Gender Code:
F

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:
1861400731
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 396
Provider Second Line Business Mailing Address:
5409 EVERYBODYS ROAD FOREST COUNTY POTAWATOMI HEALTH
Provider Business Mailing Address City Name:
CRANDON
Provider Business Mailing Address State Name:
WI
Provider Business Mailing Address Postal Code:
54520
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
715-478-4300
Provider Business Mailing Address Fax Number:
715-478-4490

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5409 EVERYBODYS ROAD
Provider Second Line Business Practice Location Address:
FOREST COUNTY POTAWATOMI HEALTH & WELLNESS CENTER
Provider Business Practice Location Address City Name:
CRANDON
Provider Business Practice Location Address State Name:
WI
Provider Business Practice Location Address Postal Code:
54520
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
715-478-4300
Provider Business Practice Location Address Fax Number:
715-478-4490
Provider Enumeration Date:
08/04/2006

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:  29406 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 93393 . This is a "SECURITY HEALTH PLAN" identifier , issued by the state of ( WI ) . This identifiers is of the category "OTHER".
  • Identifier: 31590500 , issued by the state of ( WI ) . This identifiers is of the category "MEDICAID".




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