Basic Information
Provider Information | |||||||||
NPI: | 1659488419 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BEEGLE | ||||||||
FirstName: | MARY | ||||||||
MiddleName: | E | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | DO | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 1547 | ||||||||
Address2: |   | ||||||||
City: | SEDALIA | ||||||||
State: | MO | ||||||||
PostalCode: | 653021547 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6608265960 | ||||||||
FaxNumber: | 6608264852 | ||||||||
Practice Location | |||||||||
Address1: | 119 E 4TH ST | ||||||||
Address2: |   | ||||||||
City: | SEDALIA | ||||||||
State: | MO | ||||||||
PostalCode: | 65301 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6605535298 | ||||||||
FaxNumber: | 6605535301 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 08/25/2006 | ||||||||
LastUpdateDate: | 09/06/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2084P0800X | 2006012200 | MO | Y |   | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Psychiatry |
ID Information
ID | Type | State | Issuer | Description | P00968639 | 01 | MO | RR MEDICARE | OTHER | 44394018 | 01 | MO | BCBS KC | OTHER |