Provider Demographics
NPI:1003152976
Name:BETTIS, DONALD DENNIS (BC-HIS)
Entity Type:Individual
Prefix:MR
First Name:DONALD
Middle Name:DENNIS
Last Name:BETTIS
Suffix:
Gender:M
Credentials:BC-HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1221 W SPRESSER ST
Mailing Address - Street 2:
Mailing Address - City:TAYLORVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62568-1714
Mailing Address - Country:US
Mailing Address - Phone:217-824-5210
Mailing Address - Fax:217-824-5211
Practice Address - Street 1:1221 W SPRESSER ST
Practice Address - Street 2:
Practice Address - City:TAYLORVILLE
Practice Address - State:IL
Practice Address - Zip Code:62568-1714
Practice Address - Country:US
Practice Address - Phone:217-824-5210
Practice Address - Fax:217-824-5211
Is Sole Proprietor?:No
Enumeration Date:2012-12-21
Last Update Date:2012-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1966246Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, Other