Provider Demographics
NPI:1467592113
Name:BETHESDA HOSPITAL INC
Entity Type:Organization
Organization Name:BETHESDA HOSPITAL INC
Other - Org Name:BETHESDA OB GYN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BOARD MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:S
Authorized Official - Last Name:NIENABER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-569-6386
Mailing Address - Street 1:10475 MONTGOMERY RD
Mailing Address - Street 2:SUITE 4G
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45242-5201
Mailing Address - Country:US
Mailing Address - Phone:513-745-1639
Mailing Address - Fax:
Practice Address - Street 1:10475 MONTGOMERY RD
Practice Address - Street 2:SUITE 4G
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45242-5201
Practice Address - Country:US
Practice Address - Phone:513-745-1639
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2009-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2270635Medicaid
9327581Medicare PIN