Healthcare Provider Details

I. General information

NPI: 1134176704
Provider Name (Legal Business Name): BELOIT MEDICAL CENTER, P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/28/2006
Last Update Date: 07/27/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1005 N LINCOLN AVE
BELOIT KS
67420-1215
US

IV. Provider business mailing address

PO BOX 587
BELOIT KS
67420-0587
US

V. Phone/Fax

Practice location:
  • Phone: 785-738-2246
  • Fax: 785-738-4303
Mailing address:
  • Phone: 785-738-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. CRAIG ALAN CONCANNON
Title or Position: SECRETARY/TREASURER
Credential: M.D.
Phone: 785-738-2246