Provider Demographics
NPI:1780610261
Name:CHARLES W BECK, MD, PA
Entity type:Organization
Organization Name:CHARLES W BECK, MD, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:W
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-687-9961
Mailing Address - Street 1:1515 S CLIFTON AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67218-2900
Mailing Address - Country:US
Mailing Address - Phone:316-687-9961
Mailing Address - Fax:316-687-6561
Practice Address - Street 1:1515 S CLIFTON AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67218-2900
Practice Address - Country:US
Practice Address - Phone:316-687-9961
Practice Address - Fax:316-687-6561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18811207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Single Specialty