Provider Demographics
NPI:1821270364
Name:KIMBERLY E BECK MD PC
Entity Type:Organization
Organization Name:KIMBERLY E BECK MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-528-7935
Mailing Address - Street 1:PO BOX 640
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:UT
Mailing Address - Zip Code:84634-0640
Mailing Address - Country:US
Mailing Address - Phone:435-528-7935
Mailing Address - Fax:435-528-7936
Practice Address - Street 1:76 EAST CENTER
Practice Address - Street 2:
Practice Address - City:GUNNISON
Practice Address - State:UT
Practice Address - Zip Code:84634
Practice Address - Country:US
Practice Address - Phone:435-528-7935
Practice Address - Fax:435-528-7936
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT942766401205207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT05762719301001OtherBLUE CROSS BLUE SHIELD
UT0000055991Medicare UPIN