Provider Demographics
NPI:1265857460
Name:BETHEL UNIVERSITY
Entity Type:Organization
Organization Name:BETHEL UNIVERSITY
Other - Org Name:BETHEL UNIVERSITY HEALTH SERVICES
Other - Org Type:Other Name
Authorized Official - Title/Position:EXEC. ASSISTANT TO THE PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:BERGEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:651-638-6287
Mailing Address - Street 1:3900 BETHEL DR
Mailing Address - Street 2:MSC2376
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55112-6902
Mailing Address - Country:US
Mailing Address - Phone:651-638-6215
Mailing Address - Fax:651-635-8676
Practice Address - Street 1:3900 BETHEL DR
Practice Address - Street 2:MSC2376
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55112-6902
Practice Address - Country:US
Practice Address - Phone:651-638-6215
Practice Address - Fax:651-635-8676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-25
Last Update Date:2014-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health