Provider Demographics
NPI:1477941672
Name:BEACON PAIN CLINIC
Entity Type:Organization
Organization Name:BEACON PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REBEKAH
Authorized Official - Middle Name:
Authorized Official - Last Name:GUY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:208-342-2104
Mailing Address - Street 1:115 W MAIN ST
Mailing Address - Street 2:102
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7302
Mailing Address - Country:US
Mailing Address - Phone:208-342-2104
Mailing Address - Fax:208-342-4710
Practice Address - Street 1:115 W MAIN ST
Practice Address - Street 2:102
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7302
Practice Address - Country:US
Practice Address - Phone:208-342-2104
Practice Address - Fax:208-342-4710
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-23
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDM9987208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty