Beach, Ann Pendleton
Beach, Ann Pendleton is an individual health care provider with primary practice located at 777 N Raymond St , Boise ID 83704-9251. She recently has only one registered license in Allopathic & Osteopathic Physicians / Family Medicine, which is considered as her primary health care specialty. Beach, Ann Pendleton can be contacted via phone (208) 514-2500.Contact Information
Primary practice address
777 N Raymond St
Boise ID 83704-9251
Phone: (208) 514-2500
Fax: (208) 322-7018
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Allopathic & Osteopathic Physicians / Family Medicine | 207Q00000X | M7794 | Idaho |
Profile Details
| NPI number | 1912968892 |
|---|---|
| LBN Legal business name | Beach, Ann Pendleton |
| Credentials | Doctor of Medicine (MD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Mar 30th, 2006 |
| Last updated | Feb 1st, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1912968892 | NPPES |
| Idaho | Other | 11029901 | MEDICARE PTAN |
| Idaho | MEDICAID | 805202000 | MEDICARE PTAN |
| Idaho | Other | P00031256 | MEDICARE PTAN |
| Idaho | Other | 1102998 | MEDICARE PTAN |
| Idaho | Other | 1102990 | MEDICARE PTAN |
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