1639407745 NPI number — MARIA CHRISTINE BECK CRNP

Table of content: MARIA CHRISTINE BECK CRNP (NPI 1639407745)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1639407745 NPI number — MARIA CHRISTINE BECK CRNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BECK
Provider First Name:
MARIA
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
CRNP
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:
1639407745
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 2867
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOBILE
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36652-2867
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
251-690-8889
Provider Business Mailing Address Fax Number:
251-544-2188

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
248 COX ST STE A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MOBILE
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36604-3303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
251-405-4524
Provider Business Practice Location Address Fax Number:
251-405-4521
Provider Enumeration Date:
12/01/2009

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: 363LF0000X , with the licence number:  1-093987 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 630000013 , issued by the state of ( AL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1063439065 . This is a "NPI SITE GROUP PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 011846 . This is a "MEDICARE GROUP PAYEE NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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