Healthcare Provider Details

I. General information

NPI: 1174879456
Provider Name (Legal Business Name): BEEBE PHYSICIANS NETWORK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2012
Last Update Date: 02/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29772 ARMORY ROAD
DAGSBORO DE
19939-4354
US

IV. Provider business mailing address

33663 BAYVIEW MEDICAL DRIVE UNIT 1
LEWES DE
19958
US

V. Phone/Fax

Practice location:
  • Phone: 302-732-3680
  • Fax: 302-732-3685
Mailing address:
  • Phone: 302-645-3555
  • Fax: 302-644-3560

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number StateDE

VIII. Authorized Official

Name: MISS ROBERTA A THOMAS
Title or Position: ADM. SECRETARY III
Credential:
Phone: 302-645-3555