1336107077 NPI number — MRS. AMY KAY BECKEN PT

Table of content: (NPI 1417236092)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1336107077 NPI number — MRS. AMY KAY BECKEN PT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECKEN
Provider First Name:
AMY
Provider Middle Name:
KAY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PT
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:
1336107077
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
35 STATE AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FARIBAULT
Provider Business Mailing Address State Name:
MN
Provider Business Mailing Address Postal Code:
55021-6368
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
507-497-3790
Provider Business Mailing Address Fax Number:
507-497-3722

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
35 STATE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FARIBAULT
Provider Business Practice Location Address State Name:
MN
Provider Business Practice Location Address Postal Code:
55021
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
507-332-0166
Provider Business Practice Location Address Fax Number:
507-332-8069
Provider Enumeration Date:
05/03/2006

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: 225100000X , with the licence number:  6739 , 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: 103183C572 . This is a "UCARE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 162P0BE . This is a "BCBS OF MN" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 983181027668 . This is a "PREFERRED ONE" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: HP52474 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6405481 . This is a "MEDICA, MANKATO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 2350906 . This is a "AMERICA'S PPO" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".
  • Identifier: 6405480 . This is a "MEDICA, FARIBAULT" identifier , issued by the state of ( MN ) . This identifiers is of the category "OTHER".




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