Basic Information
| Provider Information | |||||||||
| NPI: | 1750499984 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BEEKHUIZEN | ||||||||
| FirstName: | JEFF | ||||||||
| MiddleName: | A. | ||||||||
| NamePrefix: | MR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | DO | ||||||||
| OtherOrganizationName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 707 N EMPORIA ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168583460 | ||||||||
| FaxNumber: | 3168583458 | ||||||||
| Practice Location | |||||||||
| Address1: | 707 N EMPORIA ST | ||||||||
| Address2: | |||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672143707 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3168583460 | ||||||||
| FaxNumber: | 3168583458 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2006 | ||||||||
| LastUpdateDate: | 08/05/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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| NPICertificationDate: | 08/05/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 2158 | TN | N | Allopathic & Osteopathic Physicians | Family Medicine | 207Q00000X | 05-30887 | KS | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 43332226 | 05 | NM | MEDICAID | 78001561 | 05 | CO | MEDICAID | 127978 | 05 | AZ | MEDICAID | 1519315 | 05 | TN | MEDICAID |