Provider Demographics
NPI:1023033909
Name:JASPER FAMILY PHYSICIANS PC
Entity Type:Organization
Organization Name:JASPER FAMILY PHYSICIANS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECKMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-482-9555
Mailing Address - Street 1:1950 SAINT CHARLES ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-2254
Mailing Address - Country:US
Mailing Address - Phone:812-482-9555
Mailing Address - Fax:812-482-9073
Practice Address - Street 1:1950 SAINT CHARLES ST
Practice Address - Street 2:SUITE 4
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9172
Practice Address - Country:US
Practice Address - Phone:812-482-9555
Practice Address - Fax:812-482-9073
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-13
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003215A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000182798OtherANTHEM BLUE CROSS
IN100110790AMedicaid
IN212130Medicare PIN