MEDICARE: BEEZWAY SERVICES, LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1760207146
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEEZWAY SERVICES, LLC

Provider Business Mailing Address
First Line	:	6020 PORTICO DR APT 1523
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4189
Country	:	US
Telephone Number	:	817-903-1199
Fax Number	:

Provider Business Practice Location Address
First Line	:	6020 PORTICO DR APT 1523
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76132-4189
Country	:	US
Telephone Number	:	817-903-1199
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	LONI MACK
Credential	:
Telephone Number	:	817-903-1199

Provider Enumeration Date	:	11/20/2024
Last Update Date	:	11/20/2024

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Directions to “BEEZWAY SERVICES, LLC ” Practice Location

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