Healthcare Provider Details

I. General information

NPI: 1962592964
Provider Name (Legal Business Name): GARTH MERVID BEACHE M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 02/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 S JACKSON ST SUITE C07
LOUISVILLE KY
40202-1675
US

IV. Provider business mailing address

PO BOX 21249
LOUISVILLE KY
40221-0249
US

V. Phone/Fax

Practice location:
  • Phone: 502-852-5875
  • Fax: 502-852-1754
Mailing address:
  • Phone: 502-581-1500
  • Fax: 502-540-4959

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number40968
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberD0051294
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberD0051294
License Number StateMD
# 4
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number40968
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: