Healthcare Provider Details

I. General information

NPI: 1699093476
Provider Name (Legal Business Name): MIKE D BEECH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/04/2010
Last Update Date: 05/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2325 CERRILLOS ROAD
SANTA FE NM
87505
US

IV. Provider business mailing address

818 CAMINO SIERRA VIS
SANTA FE NM
87505-3018
US

V. Phone/Fax

Practice location:
  • Phone: 505-438-0010
  • Fax: 505-438-6011
Mailing address:
  • Phone: 505-438-0010
  • Fax: 505-438-6011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: