Provider Demographics
NPI:1992230841
Name:BETH R. REICH M.D. LLC
Entity type:Organization
Organization Name:BETH R. REICH M.D. LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BETH
Authorized Official - Middle Name:ROBIN
Authorized Official - Last Name:REICH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-984-8755
Mailing Address - Street 1:PO BOX 5683
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87502-5683
Mailing Address - Country:US
Mailing Address - Phone:505-984-8755
Mailing Address - Fax:
Practice Address - Street 1:546 HARKLE RD
Practice Address - Street 2:SUITE B
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4784
Practice Address - Country:US
Practice Address - Phone:505-984-8755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-28
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM81-294261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)