Provider Demographics
NPI:1235128554
Name:BIGHAM, BETH A (MD)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:A
Last Name:BIGHAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3702 SHOSHONE CIR
Mailing Address - Street 2:
Mailing Address - City:PINCKNEYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62274-4113
Mailing Address - Country:US
Mailing Address - Phone:618-357-2147
Mailing Address - Fax:618-357-8142
Practice Address - Street 1:13 N WALNUT ST
Practice Address - Street 2:
Practice Address - City:PINCKNEYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62274-1050
Practice Address - Country:US
Practice Address - Phone:618-357-2147
Practice Address - Fax:618-357-8142
Is Sole Proprietor?:No
Enumeration Date:2005-10-19
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036-079733207Q00000X
IL036.079733207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1235128554Medicaid
ILIL1682044Medicare PIN
IL933600Medicare ID - Type Unspecified
ILE15109Medicare UPIN