Provider Demographics
NPI:1770698052
Name:BECKETT, ADAM HARTY (DO)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:HARTY
Last Name:BECKETT
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CORPORATE BLVD
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:LA
Mailing Address - Zip Code:70508-3870
Mailing Address - Country:US
Mailing Address - Phone:800-893-9698
Mailing Address - Fax:
Practice Address - Street 1:1 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65212-0001
Practice Address - Country:US
Practice Address - Phone:573-882-8091
Practice Address - Fax:573-884-1902
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXP3856207P00000X
MO2006011644207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO201285301Medicaid
MO751780OtherHEALTHLINK
MO751780OtherHEALTHLINK
MO959395236Medicare PIN
MOI60068Medicare UPIN
MOP00433361Medicare PIN
MO959391878Medicare PIN