Provider Demographics
NPI:1811166325
Name:RICKY BECKER MD PC
Entity type:Organization
Organization Name:RICKY BECKER MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEBBIE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-530-3011
Mailing Address - Street 1:1500 INTERCHANGE AVE
Mailing Address - Street 2:STE 100
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58501-2079
Mailing Address - Country:US
Mailing Address - Phone:701-530-3011
Mailing Address - Fax:
Practice Address - Street 1:1500 INTERCHANGE AVE
Practice Address - Street 2:STE 100
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58501-2079
Practice Address - Country:US
Practice Address - Phone:701-530-3011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-28
Last Update Date:2008-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NDN711225OtherGROUP