Provider Demographics
NPI:1669831640
Name:LAURIE A BEACH
Entity Type:Organization
Organization Name:LAURIE A BEACH
Other - Org Name:PILOT GROVE RURAL HEALTH CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:AMELIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LEDBETTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-335-4715
Mailing Address - Street 1:212 COLLEGE ST
Mailing Address - Street 2:
Mailing Address - City:PILOT GROVE
Mailing Address - State:MO
Mailing Address - Zip Code:65276-1005
Mailing Address - Country:US
Mailing Address - Phone:660-834-5100
Mailing Address - Fax:660-834-5101
Practice Address - Street 1:212 COLLEGE ST
Practice Address - Street 2:
Practice Address - City:PILOT GROVE
Practice Address - State:MO
Practice Address - Zip Code:65276-1005
Practice Address - Country:US
Practice Address - Phone:660-834-5100
Practice Address - Fax:660-834-5101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-18
Last Update Date:2016-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty