Provider Demographics
NPI: | 1730133992 |
---|---|
Name: | BEEBE PHYSICIAN NETWORK INC. |
Entity Type: | Organization |
Organization Name: | BEEBE PHYSICIAN NETWORK INC. |
Other - Org Name: | BEEBE MEDICAL GROUP |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | VP AND CHIEF ADMINISTRATIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | STEPHEN |
Authorized Official - Middle Name: | KRAIG |
Authorized Official - Last Name: | KEISER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 302-313-2300 |
Mailing Address - Street 1: | 1515 SAVANNAH RD |
Mailing Address - Street 2: | |
Mailing Address - City: | LEWES |
Mailing Address - State: | DE |
Mailing Address - Zip Code: | 19958-1675 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 302-313-2300 |
Mailing Address - Fax: | 302-644-3560 |
Practice Address - Street 1: | 1515 SAVANNAH RD |
Practice Address - Street 2: | |
Practice Address - City: | LEWES |
Practice Address - State: | DE |
Practice Address - Zip Code: | 19958-1675 |
Practice Address - Country: | US |
Practice Address - Phone: | 302-313-2300 |
Practice Address - Fax: | 302-644-3560 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-05-20 |
Last Update Date: | 2022-06-30 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 207R00000X | Allopathic & Osteopathic Physicians | Internal Medicine | Group - Multi-Specialty | |
No | 207QA0505X | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | Group - Multi-Specialty |
No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
No | 207RG0100X | Allopathic & Osteopathic Physicians | Internal Medicine | Gastroenterology | Group - Multi-Specialty |
No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
No | 207RI0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Infectious Disease | Group - Multi-Specialty |
No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
No | 207RS0012X | Allopathic & Osteopathic Physicians | Internal Medicine | Sleep Medicine | Group - Multi-Specialty |
No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
No | 2086X0206X | Allopathic & Osteopathic Physicians | Surgery | Surgical Oncology | Group - Multi-Specialty |
No | 208M00000X | Allopathic & Osteopathic Physicians | Hospitalist | Group - Multi-Specialty | |
No | 363AM0700X | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | Group - Multi-Specialty |
No | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | Group - Multi-Specialty |
No | 363LN0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Neonatal | Group - Multi-Specialty |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
DE | 0000916002 | Medicaid | |
DE | 0000916002 | Medicaid |