Provider Demographics
NPI:1275685232
Name:MARY AKOR BEASLEY
Entity Type:Organization
Organization Name:MARY AKOR BEASLEY
Other - Org Name:TLC MEDICAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:AKOR
Authorized Official - Last Name:BEASLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:310-257-9293
Mailing Address - Street 1:25835 NARBONNE AVE
Mailing Address - Street 2:SUITE 150
Mailing Address - City:LOMITA
Mailing Address - State:CA
Mailing Address - Zip Code:90717-3074
Mailing Address - Country:US
Mailing Address - Phone:310-257-9293
Mailing Address - Fax:310-257-9294
Practice Address - Street 1:25835 NARBONNE AVE
Practice Address - Street 2:SUITE 150
Practice Address - City:LOMITA
Practice Address - State:CA
Practice Address - Zip Code:90717-3074
Practice Address - Country:US
Practice Address - Phone:310-257-9293
Practice Address - Fax:310-257-9294
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-18
Last Update Date:2008-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA5896630001Medicare NSC