Provider Demographics
NPI:1437545456
Name:BETHANY HOME CARE MHT LLC
Entity Type:Organization
Organization Name:BETHANY HOME CARE MHT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:WADE
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:MCCOY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:405-226-7169
Mailing Address - Street 1:1515 HERITAGE DR
Mailing Address - Street 2:STE 110
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75069-3256
Mailing Address - Country:US
Mailing Address - Phone:972-616-4932
Mailing Address - Fax:
Practice Address - Street 1:1515 HERITAGE DR
Practice Address - Street 2:STE 110
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75069-3256
Practice Address - Country:US
Practice Address - Phone:972-616-4932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-07
Last Update Date:2015-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK20023207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty