Healthcare Provider Details

I. General information

NPI: 1760522072
Provider Name (Legal Business Name): EARL C. BEEKS, JR., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/07/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8420 DELMAR BLVD SUITE 402
SAINT LOUIS MO
63124-2170
US

IV. Provider business mailing address

8420 DELMAR BLVD SUITE 402
SAINT LOUIS MO
63124-2170
US

V. Phone/Fax

Practice location:
  • Phone: 314-567-3232
  • Fax: 314-567-5380
Mailing address:
  • Phone: 314-567-3232
  • Fax: 314-567-5380

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number36260
License Number StateMO

VIII. Authorized Official

Name: DR. EARL C. BEEKS JR.
Title or Position: PRESIDENT
Credential: M.D.
Phone: 314-567-3232