1619975315 NPI number — ANNETTE M BECK MD

Table of content: ANNETTE M BECK MD (NPI 1619975315)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1619975315 NPI number — ANNETTE M BECK MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECK
Provider First Name:
ANNETTE
Provider Middle Name:
M
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:
1619975315
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/27/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
205 W R D MIZE RD
Provider Second Line Business Mailing Address:
SUITE 304
Provider Business Mailing Address City Name:
BLUE SPRINGS
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
64014-2518
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
816-228-4770
Provider Business Mailing Address Fax Number:
816-228-1156

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11200 E WINNER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
INDEPENDENCE
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
64052-3964
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
816-836-4300
Provider Business Practice Location Address Fax Number:
816-836-2118
Provider Enumeration Date:
07/07/2005

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: 208000000X , with the licence number:  118199 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 031550 . This is a "FAMILY HEALTH PARTNERS" identifier . This identifiers is of the category "OTHER".
  • Identifier: 5461776 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 25902011 . This is a "BLUE CROSS/BLUE SHIELD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1200339 . This is a "UNITED HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: 337290 . This is a "FIRST GUARD" identifier . This identifiers is of the category "OTHER".
  • Identifier: 204632707 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".




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