Provider Demographics
NPI:1093884769
Name:BETHANY PERFUSION, PC
Entity Type:Organization
Organization Name:BETHANY PERFUSION, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:MASSONI
Authorized Official - Suffix:
Authorized Official - Credentials:BS, CCP, LP
Authorized Official - Phone:405-787-2677
Mailing Address - Street 1:3612 N FLAMINGO AVE
Mailing Address - Street 2:
Mailing Address - City:BETHANY
Mailing Address - State:OK
Mailing Address - Zip Code:73008-3664
Mailing Address - Country:US
Mailing Address - Phone:405-787-2677
Mailing Address - Fax:405-787-2677
Practice Address - Street 1:3612 N FLAMINGO AVE
Practice Address - Street 2:
Practice Address - City:BETHANY
Practice Address - State:OK
Practice Address - Zip Code:73008-3664
Practice Address - Country:US
Practice Address - Phone:405-787-2677
Practice Address - Fax:405-787-2677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLP22246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical TechnologistGroup - Single Specialty