MEDICARE: DIANNE L BECKER EMT/DIRECTOR

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	146N00000X	Basic Emergency Medical Technician	007579	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0000019099	OTHER	KS	BLUE CROSS BLUE SHIELD

General Provider Information

NPI Number	:	1548267909
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DIANNE L BECKER EMT/DIRECTOR

Provider Business Mailing Address
First Line	:	1111 SW 8TH ST
Second Line	:
City	:	PLAINVILLE
State	:	KS
Zip	:	67663-3105
Country	:	US
Telephone Number	:	785-434-2530
Fax Number	:	785-434-2552

Provider Business Practice Location Address
First Line	:	1111 SW 8TH ST
Second Line	:
City	:	PLAINVILLE
State	:	KS
Zip	:	67663-3105
Country	:	US
Telephone Number	:	785-434-2530
Fax Number	:	785-434-2552

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

Provider Enumeration Date	:	06/30/2005
Last Update Date	:	02/13/2008

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