Basic Information
Provider Information | |||||||||
NPI: | 1538187000 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BECK | ||||||||
FirstName: | ANNE | ||||||||
MiddleName: | M | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MD | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 1465 S GRAND BLVD | ||||||||
Address2: |   | ||||||||
City: | SAINT LOUIS | ||||||||
State: | MO | ||||||||
PostalCode: | 631041003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3145775662 | ||||||||
FaxNumber: | 3142686449 | ||||||||
Practice Location | |||||||||
Address1: | 1465 S GRAND BLVD | ||||||||
Address2: |   | ||||||||
City: | ST. LOUIS | ||||||||
State: | MO | ||||||||
PostalCode: | 631041003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3142684010 | ||||||||
FaxNumber: | 3142686449 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/17/2006 | ||||||||
LastUpdateDate: | 01/15/2021 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 01/15/2021 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2080P0210X | R8N99 | MO | Y |   | Allopathic & Osteopathic Physicians | Pediatrics | Pediatric Nephrology |
ID Information
ID | Type | State | Issuer | Description | 1536407 | 05 | LA |   | MEDICAID | 1517410 | 05 | TN |   | MEDICAID | 121158 | 05 | MS |   | MEDICAID | 144010381 | 05 | MO |   | MEDICAID |