1447278650 NPI number — MRS. BETH JOHANNA BEEMAN AU.D., CCC-A

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1447278650 NPI number — MRS. BETH JOHANNA BEEMAN AU.D., CCC-A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BEEMAN
Provider First Name:
BETH
Provider Middle Name:
JOHANNA
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
AU.D., CCC-A
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:
1447278650
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2525 FOX RUN PKWY
Provider Second Line Business Mailing Address:
SUITE 101
Provider Business Mailing Address City Name:
YANKTON
Provider Business Mailing Address State Name:
SD
Provider Business Mailing Address Postal Code:
57078-5371
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
605-665-0062
Provider Business Mailing Address Fax Number:
605-665-0076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2525 FOX RUN PKWY
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
YANKTON
Provider Business Practice Location Address State Name:
SD
Provider Business Practice Location Address Postal Code:
57078-5371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
605-665-0062
Provider Business Practice Location Address Fax Number:
605-665-0076
Provider Enumeration Date:
07/17/2006

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: 237600000X , with the licence number:  305A , registered in the state of SD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 237600000X , with the licence number: 826 , registered in the state of IA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 237600000X , with the licence number: 718 , registered in the state of NE ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 10025369000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 481 . This is a "AUDIOLOGIST" identifier , issued by the state of ( IA ) . This identifiers is of the category "OTHER".
  • Identifier: 10025372000 , issued by the state of ( NE ) . This identifiers is of the category "MEDICAID".
  • Identifier: 237 . This is a "AUDIOLOGIST" identifier , issued by the state of ( NE ) . This identifiers is of the category "OTHER".
  • Identifier: 305A . This is a "AUDIOLOGIST & HA DISPENSE" identifier , issued by the state of ( SD ) . This identifiers is of the category "OTHER".




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