Provider Demographics
NPI:1972591030
Name:BELTZ, THEODORE J (DO)
Entity Type:Individual
Prefix:DR
First Name:THEODORE
Middle Name:J
Last Name:BELTZ
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:601 E 14TH ST
Mailing Address - Street 2:P O BOX 1706
Mailing Address - City:SEDALIA
Mailing Address - State:MO
Mailing Address - Zip Code:65301-5972
Mailing Address - Country:US
Mailing Address - Phone:866-678-5627
Mailing Address - Fax:660-827-3742
Practice Address - Street 1:1765 COMMERCIAL ST
Practice Address - Street 2:
Practice Address - City:WARSAW
Practice Address - State:MO
Practice Address - Zip Code:65355-3096
Practice Address - Country:US
Practice Address - Phone:660-438-6800
Practice Address - Fax:660-438-6525
Is Sole Proprietor?:No
Enumeration Date:2005-10-12
Last Update Date:2014-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO110839207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO566161OtherHEALTHLINK PIN
MO7264017OtherAETNA PIN
MOG92800OtherMERCY HEALTH PLANS PIN
MO0102227OtherUNITED HEALTHCARE PIN
MOG92800OtherCIGNA PIN
MO244629614Medicaid
MO26841021OtherBLUE CROSS BLUE SHIELD PIN
MOG92800OtherTRICARE PIN
MOG92800OtherTRICARE PIN
MOG92800OtherCIGNA PIN