1528080686 NPI number — GARY D BEAUCHAMP MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528080686 NPI number — GARY D BEAUCHAMP MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

BEAUCHAMP

Provider First Name:

GARY

Provider Middle Name:

D

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:

1528080686

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/18/2013

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

5501 NW 62ND TER

Provider Second Line Business Mailing Address:

SUITE 201

Provider Business Mailing Address City Name:

KANSAS CITY

Provider Business Mailing Address State Name:

MO

Provider Business Mailing Address Postal Code:

64151-2411

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

816-584-8884

Provider Business Mailing Address Fax Number:

913-588-9220

Provider First Line Business Practice Location Address:

1530 N CHURCH RD

Provider Second Line Business Practice Location Address:

Provider Business Practice Location Address City Name:

LIBERTY

Provider Business Practice Location Address State Name:

MO

Provider Business Practice Location Address Postal Code:

64068-7129

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

816-781-1696

Provider Business Practice Location Address Fax Number:

816-781-5438

Provider Enumeration Date:

07/24/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  R5969 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
• Taxonomy code: 207RC0000X , with the licence number: 04-14844 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

• Identifier: 225043 . This is a "HEALTHLINK-NCPPO" identifier . This identifiers is of the category "OTHER".
• Identifier: 4001285 . This is a "MO & KS / AETNA PPO & HMO" identifier . This identifiers is of the category "OTHER".
• Identifier: 557640 . This is a "FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
• Identifier: 151824XX . This is a "PREFERRED CARE NY" identifier . This identifiers is of the category "OTHER".
• Identifier: 504290 . This is a "FIRST GUARD HLTH PLAN" identifier . This identifiers is of the category "OTHER".
• Identifier: 10001216901 . This is a "COMMUNITY HLTH PLAN OF MO" identifier . This identifiers is of the category "OTHER".
• Identifier: 100202570A , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".
• Identifier: 051563 . This is a "BCBS KS OUTREACH CLINICS" identifier , issued by the state of ( KS ) . This identifiers is of the category "OTHER".
• Identifier: 04472015 . This is a "BCBS KC" identifier . This identifiers is of the category "OTHER".
• Identifier: 200019503 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
• Identifier: 100202570B , issued by the state of ( KS ) . This identifiers is of the category "MEDICAID".