Basic Information
| Provider Information | |||||||||
| NPI: | 1306590054 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BECKETT SPRINGS PHYSICIAN GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 S 5TH ST STE 3850 | ||||||||
| Address2: | |||||||||
| City: | LOUISVILLE | ||||||||
| State: | KY | ||||||||
| PostalCode: | 402023127 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4125883546 | ||||||||
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| Practice Location | |||||||||
| Address1: | 5571 CHEVIOT RD | ||||||||
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| City: | CINCINNATI | ||||||||
| State: | OH | ||||||||
| PostalCode: | 452477020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5137131050 | ||||||||
| FaxNumber: | 5136554700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/10/2022 | ||||||||
| LastUpdateDate: | 02/10/2022 | ||||||||
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| AuthorizedOfficialLastName: | LICHNEROWICZ | ||||||||
| AuthorizedOfficialFirstName: | DARCY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5138540913 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BECKETT SPRINGS, LLC | ||||||||
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| NPICertificationDate: | 02/10/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
No ID Information.