Provider Demographics
NPI:1124375241
Name:BEEBE PHYSICIANS NETWORK, INC.
Entity Type:Organization
Organization Name:BEEBE PHYSICIANS NETWORK, INC.
Other - Org Name:BEEBE SUSSEX WELLNESS BEEBE MEDICAL GROUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADM. SECRETARY
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-645-3555
Mailing Address - Street 1:33663 BAYVIEW MEDICAL DRIVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-645-3555
Mailing Address - Fax:302-644-3560
Practice Address - Street 1:26026 PATRIOTS WAY
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:DE
Practice Address - Zip Code:19947
Practice Address - Country:US
Practice Address - Phone:302-934-5962
Practice Address - Fax:302-934-5965
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEEBE PHYSICIANS NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-08-08
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPENDINGMedicaid