Provider Demographics
NPI:1366866378
Name:TETHYS HEALTH VENTURES LLC
Entity Type:Organization
Organization Name:TETHYS HEALTH VENTURES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SENIOR VP OF IT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-771-0692
Mailing Address - Street 1:4 N PARK DR STE 104
Mailing Address - Street 2:
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21030-1806
Mailing Address - Country:US
Mailing Address - Phone:410-771-0692
Mailing Address - Fax:410-771-0696
Practice Address - Street 1:4 N PARK DR STE 104
Practice Address - Street 2:
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21030-1806
Practice Address - Country:US
Practice Address - Phone:410-771-0692
Practice Address - Fax:410-771-0696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-11
Last Update Date:2014-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR120718251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management