Provider Demographics
NPI:1346958766
Name:BETHEL CLINIC & URGENT CARE
Entity Type:Organization
Organization Name:BETHEL CLINIC & URGENT CARE
Other - Org Name:BETHEL FAMILY CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHUKS
Authorized Official - Middle Name:B
Authorized Official - Last Name:AKAEZE
Authorized Official - Suffix:
Authorized Official - Credentials:RN/BSN
Authorized Official - Phone:708-506-3188
Mailing Address - Street 1:1705 E SAUK TRL
Mailing Address - Street 2:
Mailing Address - City:SAUK VILLAGE
Mailing Address - State:IL
Mailing Address - Zip Code:60411-4955
Mailing Address - Country:US
Mailing Address - Phone:708-506-3188
Mailing Address - Fax:
Practice Address - Street 1:1705 E SAUK TRL
Practice Address - Street 2:
Practice Address - City:SAUK VILLAGE
Practice Address - State:IL
Practice Address - Zip Code:60411-4955
Practice Address - Country:US
Practice Address - Phone:708-506-3188
Practice Address - Fax:815-205-4821
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-15
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL1649641747Medicaid
IL1346958766OtherPRACTICE NPI