1922064401 NPI number — ANITA L BEACH NP

Table of content: ANITA L BEACH NP (NPI 1922064401)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922064401 NPI number — ANITA L BEACH NP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEACH
Provider First Name:
ANITA
Provider Middle Name:
L
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
NP
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:
1922064401
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/30/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1111 BAKER AVE
Provider Second Line Business Mailing Address:
GLACIER MEDICAL ASSOCIATES
Provider Business Mailing Address City Name:
WHITEFISH
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59937-2901
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-862-2515
Provider Business Mailing Address Fax Number:
406-862-4229

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1111 BAKER AVE
Provider Second Line Business Practice Location Address:
GLACIER MEDICAL ASSOCIATES
Provider Business Practice Location Address City Name:
WHITEFISH
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59937-2901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-862-2515
Provider Business Practice Location Address Fax Number:
406-862-4229
Provider Enumeration Date:
04/25/2006

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:  RN024700 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN024700 . This is a "MONTANA STATE LICENSE" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 500004073 . This is a "RAILROAD MEDICARE PIN#" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 27D0411341 . This is a "CLIA ID#---LAB CERT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0432157 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1104882232 . This is a "GLACIER MEDICAL ASSOC NPI" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: CI2709 . This is a "RAILROAD MEDICARE GRP ID#" identifier , issued by the state of ( NV ) . This identifiers is of the category "OTHER".
  • Identifier: 000037436 . This is a "BLUE CORSS/SHIELD PIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 810350909 . This is a "FEIN" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 000008287 . This is a "MEDICARE PART B GRP ID#" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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