Provider Demographics
NPI:1164596326
Name:BETHESDA CARE EASTGATE
Entity Type:Organization
Organization Name:BETHESDA CARE EASTGATE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FACILITY MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CHUC
Authorized Official - Middle Name:PHUC
Authorized Official - Last Name:LE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-752-3695
Mailing Address - Street 1:10185 WATERSIDE CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-9489
Mailing Address - Country:US
Mailing Address - Phone:859-384-7221
Mailing Address - Fax:
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:2006-11-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35071748261QX0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QX0100XAmbulatory Health Care FacilitiesClinic/CenterOccupational Medicine