Provider Demographics
NPI:1225655962
Name:SETH KLEINBECK, M.D., P.A
Entity Type:Organization
Organization Name:SETH KLEINBECK, M.D., P.A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JESSICA
Authorized Official - Middle Name:MEGAN
Authorized Official - Last Name:DEWITT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:870-236-2911
Mailing Address - Street 1:2210 W KINGSHIGHWAY STE 7
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-3987
Mailing Address - Country:US
Mailing Address - Phone:870-236-2911
Mailing Address - Fax:870-236-2912
Practice Address - Street 1:2210 W KINGSHIGHWAY STE 7
Practice Address - Street 2:
Practice Address - City:PARAGOULD
Practice Address - State:AR
Practice Address - Zip Code:72450-3987
Practice Address - Country:US
Practice Address - Phone:870-236-2911
Practice Address - Fax:870-236-2912
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SETH KLEINBECK, M.D., P.A.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-06-29
Last Update Date:2020-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty