MEDICARE: MR. ANTHONY BECKHAM REGISTERED NURSE

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	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1700981289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ANTHONY BECKHAM REGISTERED NURSE

Provider Business Mailing Address
First Line	:	1601 MAIN ST.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202
Country	:	US
Telephone Number	:	513-721-3482
Fax Number	:	513-721-3483

Provider Business Practice Location Address
First Line	:	1601 MAIN ST.
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202
Country	:	US
Telephone Number	:	513-721-3482
Fax Number	:	513-721-3483

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

Provider Enumeration Date	:	09/13/2006
Last Update Date	:	11/02/2012

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