Provider Demographics
NPI:1720059918
Name:HILL, BECKI SUE (MD)
Entity Type:Individual
Prefix:
First Name:BECKI
Middle Name:SUE
Last Name:HILL
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2428 W PIERCE ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3512
Mailing Address - Country:US
Mailing Address - Phone:575-887-0272
Mailing Address - Fax:
Practice Address - Street 1:2428 W PIERCE ST
Practice Address - Street 2:SUITE 102
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3512
Practice Address - Country:US
Practice Address - Phone:575-887-0272
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2022-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD062281L2085R0001X
WV210172085R0001X
KY386272085R0001X
NMMD2014-00532085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVG71537Medicare UPIN
WV7125659OtherAETNA
WV4092884Medicare PIN
WVP00914310OtherRAILROAD MEDICARE
PAG71537Medicare UPIN
PA049251Medicare PIN
PA001859561Medicaid
KY0169Medicare PIN
WV3604385OtherCIGNA
WV2003926000Medicaid