Basic Information
| Provider Information | |||||||||
| NPI: | 1912014077 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BECKENHAUER | ||||||||
| FirstName: | DWANE | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 501 S SANTA FE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854527269 | ||||||||
| FaxNumber: | 7854526008 | ||||||||
| Practice Location | |||||||||
| Address1: | 501 S SANTA FE AVE | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | SALINA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 674014189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7854527245 | ||||||||
| FaxNumber: | 7854527246 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/24/2006 | ||||||||
| LastUpdateDate: | 05/25/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 0420676 | KS | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 100205490C | 05 | KS | MEDICAID |