MEDICARE: WILLIAM T BEASLEY PSC

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	213E00000X	Podiatrist
2	332B00000X	Durable Medical Equipment & Medical Supplies	00126	KY

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	:	1467506501
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM T BEASLEY PSC

Provider Business Mailing Address
First Line	:	4602 SOUTHERN PKWY
Second Line	:	1B
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-366-1479
Fax Number	:	502-366-6718

Provider Business Practice Location Address
First Line	:	4602 SOUTHERN PKWY
Second Line	:	1B
City	:	LOUISVILLE
State	:	KY
Zip	:	40214-1442
Country	:	US
Telephone Number	:	502-366-1479
Fax Number	:	502-366-6718

Authorized Official
Title or Position	:	OWNER
Name	:	DR. WILLIAM T BEASLEY
Credential	:	DPM
Telephone Number	:	502-366-1479

Provider Enumeration Date	:	01/23/2007
Last Update Date	:	08/28/2013

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Directions to “WILLIAM T BEASLEY PSC ” Practice Location

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