Provider Demographics
NPI:1912118779
Name:BAGDAD CONSULTING PHYSICIANS GROUP
Entity type:Organization
Organization Name:BAGDAD CONSULTING PHYSICIANS GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BECK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:928-633-6011
Mailing Address - Street 1:PO BOX 948
Mailing Address - Street 2:
Mailing Address - City:BAGDAD
Mailing Address - State:AZ
Mailing Address - Zip Code:86321-0948
Mailing Address - Country:US
Mailing Address - Phone:928-633-6011
Mailing Address - Fax:928-633-3376
Practice Address - Street 1:12 HOPE DRIVE
Practice Address - Street 2:
Practice Address - City:BAGDAD
Practice Address - State:AZ
Practice Address - Zip Code:86321
Practice Address - Country:US
Practice Address - Phone:928-633-6011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-24
Last Update Date:2011-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZMD19960OtherPTAN