1912901851 NPI number — JAMES BEITZEL MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912901851 NPI number — JAMES BEITZEL MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BEITZEL

Provider First Name:

JAMES

Provider Middle Name:

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1912901851

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

10/17/2022

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

11109 PARKVIEW PLAZA DR STE 3

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT WAYNE

Provider Business Mailing Address State Name:

IN

Provider Business Mailing Address Postal Code:

46845-1701

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

260-266-6013

Provider Business Mailing Address Fax Number:

Provider First Line Business Practice Location Address:

1270 E STATE ROAD 205

Provider Second Line Business Practice Location Address:

SUITE 210

Provider Business Practice Location Address City Name:

COLUMBIA CITY

Provider Business Practice Location Address State Name:

IN

Provider Business Practice Location Address Postal Code:

46725-9499

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

260-248-9230

Provider Business Practice Location Address Fax Number:

260-248-9249

Provider Enumeration Date:

06/09/2005

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207R00000X , with the licence number:  MD034166E , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207Q00000X , with the licence number: 01061931A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 000000570559 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 200855470 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
• Identifier: 21412 . This is a "PHP" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: P00465455 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 001083302 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
• Identifier: 351972384027 . This is a "TRICARE" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 1194655 . This is a "CIGNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 4239333 . This is a "AETNA" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 000000513051 . This is a "ANTHEM" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".
• Identifier: 3937240002 . This is a "MEDICARE DMEPOS" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".