Provider Demographics
NPI:1659488419
Name:BEEGLE, MARY ELLEN (DO)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:ELLEN
Last Name:BEEGLE
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:119 EAST 4TH STREET
Mailing Address - Street 2:
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301
Mailing Address - Country:US
Mailing Address - Phone:660-553-5298
Mailing Address - Fax:660-553-5301
Practice Address - Street 1:119 EAST 4TH STREET
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301
Practice Address - Country:US
Practice Address - Phone:660-553-5298
Practice Address - Fax:660-553-5301
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-25
Last Update Date:2023-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20060122002084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
MOP00968639OtherRR MEDICARE
MO44394018OtherBCBS KC
MOMA2175Medicare PIN
NDN712663Medicare PIN
ND28651OtherND BCBS
MN889694100Medicaid
ND13409Medicaid
NC025533OtherBCBS OF ND PIN
925G5BEOtherMN BCBS