MEDICARE: MAISHA LASHAWN BEAUCHAMP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	343900000X	Non-emergency Medical Transport (VAN)	010781841	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1568101095
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MAISHA LASHAWN BEAUCHAMP

Provider Business Mailing Address
First Line	:	1434 MAIN ST STE A
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-2838
Country	:	US
Telephone Number	:	225-522-0502
Fax Number	:

Provider Business Practice Location Address
First Line	:	1434 MAIN ST STE A
Second Line	:
City	:	BAKER
State	:	LA
Zip	:	70714-2838
Country	:	US
Telephone Number	:	225-522-0502
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2022
Last Update Date	:	06/02/2022

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