Provider Demographics
NPI:1629014402
Name:BRADY, BETH (CRNA)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:
Last Name:BRADY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1507 315TH ST
Mailing Address - Street 2:
Mailing Address - City:EAGLE GROVE
Mailing Address - State:IA
Mailing Address - Zip Code:50533-8014
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1316 S MAIN ST
Practice Address - Street 2:
Practice Address - City:CLARION
Practice Address - State:IA
Practice Address - Zip Code:50525-2019
Practice Address - Country:US
Practice Address - Phone:515-532-2811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2023-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA087477207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0600460Medicaid
IA0655001Medicaid
IA0293522Medicaid
IA0424507Medicaid
IA0635011Medicaid
IA0283465Medicaid
IA16Z302Medicare Oscar/Certification
IA29352Medicare ID - Type UnspecifiedMEDICARE PART B
IA161302Medicare Oscar/Certification
IA0381980001Medicare NSC
IA0424507Medicaid
IA0655001Medicaid
IADA1838Medicare ID - Type UnspecifiedRR MEDICARE - CLINIC
IAS53070Medicare UPIN