MEDICARE: BETH A BIGHAM M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	036-079733	IL
2	207P00000X	Emergency Medicine Physician	036.079733	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235128554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETH A BIGHAM M.D.

Provider Business Mailing Address
First Line	:	3702 SHOSHONE CIR
Second Line	:
City	:	PINCKNEYVILLE
State	:	IL
Zip	:	62274-4113
Country	:	US
Telephone Number	:	618-357-2147
Fax Number	:	618-357-8142

Provider Business Practice Location Address
First Line	:	13 N WALNUT ST
Second Line	:
City	:	PINCKNEYVILLE
State	:	IL
Zip	:	62274-1050
Country	:	US
Telephone Number	:	618-357-2147
Fax Number	:	618-357-8142

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/19/2005
Last Update Date	:	09/02/2010

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Directions to “ BETH A BIGHAM M.D.” Practice Location

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