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NPI Code Detail

MEDICARE: MR. RANDALL RENEE BEECH MD

MEDICARE:  MR. RANDALL RENEE BEECH  MD
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
1208600000XSurgery Physician19302KS

Medicare Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
2020007135OTHERKSRAILROAD MEDICARE

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
10004070428OTHERKSAETNA
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1396744223
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. RANDALL RENEE BEECH MD
Provider Business Mailing Address
First Line : PO BOX 780515
Second Line :
City : WICHITA
State : KS
Zip : 67278-0515
Country : US
Telephone Number : 316-636-1129
Fax Number : 316-218-0681
Provider Business Practice Location Address
First Line : 750 AVE D WEST
Second Line :
City : KINGMAN
State : KS
Zip : 67068-1268
Country : US
Telephone Number : 620-532-3147
Fax Number : 620-532-5221
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2005
Last Update Date : 11/30/2010

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Directions to “ MR. RANDALL RENEE BEECH MD” Practice Location

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