MEDICARE: BECKLEY MEDICAL SUPPLY CO.

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	332B00000X	Durable Medical Equipment & Medical Supplies

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
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1578781407
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BECKLEY MEDICAL SUPPLY CO.

Provider Business Mailing Address
First Line	:	2000 S BECKLEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-2210
Country	:	US
Telephone Number	:	214-946-6135
Fax Number	:	214-946-6730

Provider Business Practice Location Address
First Line	:	2000 S BECKLEY AVE
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75224-2210
Country	:	US
Telephone Number	:	214-946-6135
Fax Number	:	214-946-6730

Authorized Official
Title or Position	:	OWNERPARTNER
Name	:	MR. LEROY V FINLEY SR.
Credential	:
Telephone Number	:	214-946-6135

Provider Enumeration Date	:	04/24/2007
Last Update Date	:	05/20/2008

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