1003978156 NPI number — LEE H BEECHER MD PA

Table of content: MR. FRANK MANZO III MA (NPI 1275868945)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1003978156 NPI number — LEE H BEECHER MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEE H BEECHER MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1003978156
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6600 EXCELSIOR BLVD
Provider Second Line Business Mailing Address:
CREEKSIDE BLDG SUITE 121
Provider Business Mailing Address City Name:
ST LOUIS PARK
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55426-4746
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
952-935-7116
Provider Business Mailing Address Fax Number:
952-935-0687

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6600 EXCELSIOR BLVD
Provider Second Line Business Practice Location Address:
CREEKSIDE BLDG SUITE 121
Provider Business Practice Location Address City Name:
ST LOUIS PARK
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55426-4746
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
952-935-7116
Provider Business Practice Location Address Fax Number:
952-935-0687
Provider Enumeration Date:
12/15/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BEECHER
Authorized Official First Name:
LEE
Authorized Official Middle Name:
H
Authorized Official Title or Position:
PSYCHIATRIST
Authorized Official Telephone Number:
952-935-7116

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X , with the licence number:  17314 , registered in the state of MN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0863637 . This is a "MEDICAL ASSISTANCE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 01048BE . This is a "BCBS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".