MEDICARE: GRGICH PC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103T00000X	Psychologist	PY0413	NV

General Provider Information

NPI Number	:	1124081757
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GRGICH PC

Provider Business Mailing Address
First Line	:	PO BOX 939
Second Line	:
City	:	PAHRUMP
State	:	NV
Zip	:	89041-0939
Country	:	US
Telephone Number	:	775-751-1349
Fax Number	:	775-727-5551

Provider Business Practice Location Address
First Line	:	1601 E BASIN
Second Line	:	SUITE 302
City	:	PAHRUMP
State	:	NV
Zip	:	89060-4612
Country	:	US
Telephone Number	:	775-751-1349
Fax Number	:	775-727-5551

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BECKIE M GRGICH
Credential	:	PSYD
Telephone Number	:	775-751-1349

Provider Enumeration Date	:	04/06/2006
Last Update Date	:	10/12/2007

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