Provider Demographics
NPI:1174879456
Name:BEEBE PHYSICIANS NETWORK, INC
Entity type:Organization
Organization Name:BEEBE PHYSICIANS NETWORK, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADM. SECRETARY III
Authorized Official - Prefix:MISS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:A
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:302-645-3555
Mailing Address - Street 1:33663 BAYVIEW MEDICAL DRIVE
Mailing Address - Street 2:UNIT 1
Mailing Address - City:LEWES
Mailing Address - State:DE
Mailing Address - Zip Code:19958
Mailing Address - Country:US
Mailing Address - Phone:302-645-3555
Mailing Address - Fax:302-644-3560
Practice Address - Street 1:29772 ARMORY ROAD
Practice Address - Street 2:
Practice Address - City:DAGSBORO
Practice Address - State:DE
Practice Address - Zip Code:19939-4354
Practice Address - Country:US
Practice Address - Phone:302-732-3680
Practice Address - Fax:302-732-3685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BEEBE PHYSICIAN NETWORK, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-24
Last Update Date:2016-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DE261QS1000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
DEPENDINGMedicaid