Provider Demographics
NPI:1386199974
Name:BETHESDA HEALTH OUTPATIENT SERVICES, INC.
Entity Type:Organization
Organization Name:BETHESDA HEALTH OUTPATIENT SERVICES, INC.
Other - Org Name:BETHESDA HEALTH URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT AND CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:ROGER
Authorized Official - Middle Name:L
Authorized Official - Last Name:KIRK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-737-7733
Mailing Address - Street 1:10520 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3179
Mailing Address - Country:US
Mailing Address - Phone:561-204-9355
Mailing Address - Fax:561-795-7799
Practice Address - Street 1:10520 FOREST HILL BLVD
Practice Address - Street 2:SUITE 300
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3179
Practice Address - Country:US
Practice Address - Phone:561-204-9355
Practice Address - Fax:561-795-7799
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA HOSPITAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-08-24
Last Update Date:2016-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLNA NOT FOR PROFIT261QU0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent Care