Provider Demographics
NPI:1255329942
Name:BETHESDA RESOURCES INC
Entity Type:Organization
Organization Name:BETHESDA RESOURCES INC
Other - Org Name:BETHESDA CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C.E.O.
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:P
Authorized Official - Last Name:STOKES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-383-3325
Mailing Address - Street 1:PO BOX 2649
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35662-2649
Mailing Address - Country:US
Mailing Address - Phone:256-383-3325
Mailing Address - Fax:256-383-5911
Practice Address - Street 1:505 W LOUISE AVE
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-1517
Practice Address - Country:US
Practice Address - Phone:256-383-3325
Practice Address - Fax:256-383-5911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-07
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015885Medicaid
MS09015886Medicaid
MS09015886Medicaid
MOCJ3608Medicare PIN
MSCJ3321Medicare PIN
MS09015885Medicaid