Healthcare Provider Details

I. General information

NPI: 1164987988
Provider Name (Legal Business Name): MR. ZACKARY JAMES BEBEE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2957 HIGHWAY 85 SW
BELFIELD ND
58622-9300
US

IV. Provider business mailing address

PO BOX 367
BELFIELD ND
58622-0367
US

V. Phone/Fax

Practice location:
  • Phone: 406-654-7526
  • Fax:
Mailing address:
  • Phone: 406-654-7526
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: