MEDICARE: JILL ANN BEACH DO

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	207Q00000X	Family Medicine Physician	R-12574	IA
2	207Q00000X	Family Medicine Physician	DO-06933	IA

General Provider Information

NPI Number	:	1306585245
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JILL ANN BEACH DO

Provider Business Mailing Address
First Line	:	6400 HICKMAN RD
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-5001
Country	:	US
Telephone Number	:	515-274-3551
Fax Number	:

Provider Business Practice Location Address
First Line	:	6400 HICKMAN RD
Second Line	:
City	:	WINDSOR HEIGHTS
State	:	IA
Zip	:	50324-5001
Country	:	US
Telephone Number	:	515-274-3551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/31/2022
Last Update Date	:	08/04/2025

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