MEDICARE: THOMAS J BEASLEY MD

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	207P00000X	Emergency Medicine Physician	N5884	AR

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	50361	OTHER	AR	MEDICARE PROVIDER NUMBER

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	50361	OTHER	AR	BCBS PROVIDER NUMBER

General Provider Information

NPI Number	:	1477580330
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS J BEASLEY MD

Provider Business Mailing Address
First Line	:	PO BOX 1617
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72336-1617
Country	:	US
Telephone Number	:	870-633-7742
Fax Number	:	870-633-9003

Provider Business Practice Location Address
First Line	:	1204 N WASHINGTON ST
Second Line	:
City	:	FORREST CITY
State	:	AR
Zip	:	72335-2121
Country	:	US
Telephone Number	:	870-633-7742
Fax Number	:	870-633-9003

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

Provider Enumeration Date	:	06/27/2006
Last Update Date	:	03/14/2008

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