Provider Demographics
NPI:1144419672
Name:NEIL M. BEALKA JR.,M.D. PA
Entity type:Organization
Organization Name:NEIL M. BEALKA JR.,M.D. PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:ALVIA
Authorized Official - Middle Name:A
Authorized Official - Last Name:ROBLES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:254-865-4267
Mailing Address - Street 1:2406 S. BUSINESS HWY 36
Mailing Address - Street 2:
Mailing Address - City:GATESVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:76528-2518
Mailing Address - Country:US
Mailing Address - Phone:254-865-4267
Mailing Address - Fax:254-865-8293
Practice Address - Street 1:2406 S. BUSINESS HWY 36
Practice Address - Street 2:
Practice Address - City:GATESVILLE
Practice Address - State:TX
Practice Address - Zip Code:76528
Practice Address - Country:US
Practice Address - Phone:254-865-4267
Practice Address - Fax:254-865-8293
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ3044207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141555601Medicaid
TX133678608Medicaid
TX8246M0OtherBLUE CROSS
TX141555601Medicaid
TX8524J0Medicare PIN
TX133678608Medicaid
TX180038614Medicare PIN
TX8246M0Medicare PIN