Provider Demographics
NPI:1134176704
Name:BELOIT MEDICAL CENTER, P.A.
Entity type:Organization
Organization Name:BELOIT MEDICAL CENTER, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY/TREASURER
Authorized Official - Prefix:DR
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:ALAN
Authorized Official - Last Name:CONCANNON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:785-738-2246
Mailing Address - Street 1:PO BOX 587
Mailing Address - Street 2:
Mailing Address - City:BELOIT
Mailing Address - State:KS
Mailing Address - Zip Code:67420-0587
Mailing Address - Country:US
Mailing Address - Phone:785-738-2246
Mailing Address - Fax:
Practice Address - Street 1:1005 N LINCOLN AVE
Practice Address - Street 2:
Practice Address - City:BELOIT
Practice Address - State:KS
Practice Address - Zip Code:67420-1215
Practice Address - Country:US
Practice Address - Phone:785-738-2246
Practice Address - Fax:785-738-4303
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS003910OtherKS. BLUE SHIELD
KS100088300AMedicaid
KS016893Medicare ID - Type UnspecifiedSATELLITE CLINIC
CD8236Medicare PIN
KS016755Medicare ID - Type UnspecifiedSATELLITE CLINIC
KS110351Medicare ID - Type Unspecified
KS100088300AMedicaid
0346050001Medicare PIN
KS003910OtherKS. BLUE SHIELD
KS17-3900Medicare Oscar/Certification