Provider Demographics
NPI:1477981793
Name:BEACHUM, ANTOINE MOURY'E (CMA)
Entity Type:Individual
Prefix:MR
First Name:ANTOINE
Middle Name:MOURY'E
Last Name:BEACHUM
Suffix:
Gender:M
Credentials:CMA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1114
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:TX
Mailing Address - Zip Code:75146-8114
Mailing Address - Country:US
Mailing Address - Phone:214-991-5619
Mailing Address - Fax:469-779-6112
Practice Address - Street 1:4030 PASSAGE WAY
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75146-0106
Practice Address - Country:US
Practice Address - Phone:214-991-5619
Practice Address - Fax:469-779-6112
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2016-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide