Provider Demographics
NPI:1497776462
Name:BETHESDA HOSPITAL INC
Entity Type:Organization
Organization Name:BETHESDA HOSPITAL INC
Other - Org Name:BETHESDA ARROW SPRINGS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-872-3550
Mailing Address - Street 1:100 ARROW SPRINGS BLVD
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:OH
Mailing Address - Zip Code:45036-7002
Mailing Address - Country:US
Mailing Address - Phone:513-282-7020
Mailing Address - Fax:513-282-7021
Practice Address - Street 1:100 ARROW SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:OH
Practice Address - Zip Code:45036-7002
Practice Address - Country:US
Practice Address - Phone:513-282-7020
Practice Address - Fax:513-282-7021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
OHCLPH020280300033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2650091Medicaid
2080382OtherPK