Provider Demographics
NPI:1073768099
Name:BETHESDA HEALTHCARE, INC
Entity Type:Organization
Organization Name:BETHESDA HEALTHCARE, INC
Other - Org Name:BETHESDA CARE EASTGATE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANNON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-977-0005
Mailing Address - Street 1:PO BOX 630185
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-0185
Mailing Address - Country:US
Mailing Address - Phone:513-891-7230
Mailing Address - Fax:513-891-7354
Practice Address - Street 1:4452 EASTGATE BLVD
Practice Address - Street 2:SUITE 101
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45245-1584
Practice Address - Country:US
Practice Address - Phone:513-752-3695
Practice Address - Fax:513-752-3039
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-18
Last Update Date:2008-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2083X0100XAllopathic & Osteopathic PhysiciansPreventive MedicineOccupational MedicineGroup - Multi-Specialty