Provider Demographics
NPI:1912061318
Name:BECKMAN
Entity Type:Organization
Organization Name:BECKMAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MHP
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:ELIZABETH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-456-2711
Mailing Address - Street 1:1547 PARKWAY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:GREENWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29646-4081
Mailing Address - Country:US
Mailing Address - Phone:864-229-7120
Mailing Address - Fax:
Practice Address - Street 1:45 W MAIN ST
Practice Address - Street 2:
Practice Address - City:WARE SHOALS
Practice Address - State:SC
Practice Address - Zip Code:29692-1440
Practice Address - Country:US
Practice Address - Phone:864-456-2711
Practice Address - Fax:864-456-4470
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC421504Medicaid