Provider Demographics
NPI:1063686954
Name:BEATTY PA
Entity Type:Organization
Organization Name:BEATTY PA
Other - Org Name:NEUROSURGERY OF KC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ACCOUNTS RECEIVABLE
Authorized Official - Prefix:
Authorized Official - First Name:LETITIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROEBUCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-299-9507
Mailing Address - Street 1:2040 HUTTON RD STE 105
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:KS
Mailing Address - Zip Code:66109-4564
Mailing Address - Country:US
Mailing Address - Phone:913-299-9507
Mailing Address - Fax:913-299-9542
Practice Address - Street 1:2040 HUTTON RD STE 105
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:KS
Practice Address - Zip Code:66109-4564
Practice Address - Country:US
Practice Address - Phone:913-299-9507
Practice Address - Fax:913-299-9542
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-22
Last Update Date:2008-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-20675207T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KSB74197Medicare UPIN