Provider Demographics
NPI:1093005423
Name:BECKY GRAHAM, D.O., P.C.
Entity Type:Organization
Organization Name:BECKY GRAHAM, D.O., P.C.
Other - Org Name:WOMEN'S CARE CONNECTION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BECKY
Authorized Official - Middle Name:
Authorized Official - Last Name:GRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:816-388-2229
Mailing Address - Street 1:1004 CARONDELET DR
Mailing Address - Street 2:SUITE 460
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64114-4801
Mailing Address - Country:US
Mailing Address - Phone:816-388-2229
Mailing Address - Fax:816-872-1551
Practice Address - Street 1:1004 CARONDELET DR
Practice Address - Street 2:SUITE 460
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64114-4801
Practice Address - Country:US
Practice Address - Phone:816-388-2229
Practice Address - Fax:816-872-1551
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-19
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103674207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100330060Medicaid
MO245693403Medicaid
MOY36C605OtherMEDICARE
KS100330060Medicaid