1013900950 NPI number — BETH A BESAW MD

Table of content: BETH A BESAW MD (NPI 1013900950)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013900950 NPI number — BETH A BESAW MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BESAW
Provider First Name:
BETH
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
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:
1013900950
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/30/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 RALSTON AVE
Provider Second Line Business Mailing Address:
SUITE 104
Provider Business Mailing Address City Name:
DEFIANCE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
43512-5311
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
419-783-6995
Provider Business Mailing Address Fax Number:
419-784-1603

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 RALSTON AVE
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
DEFIANCE
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43512-5311
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
419-783-6995
Provider Business Practice Location Address Fax Number:
419-784-1606
Provider Enumeration Date:
08/25/2005

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:  35075892 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 2166507 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000340015 . This is a "ANTHEM" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 7656122 . This is a "AETNA" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 2-95562 . This is a "UHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: P00158158 . This is a "RRMC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 03593 . This is a "PHC" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com