Provider Demographics
NPI:1629676317
Name:BETHEL HILLS INTEGRATED HEALTHCARE PLLC
Entity Type:Organization
Organization Name:BETHEL HILLS INTEGRATED HEALTHCARE PLLC
Other - Org Name:BETHEL HILLS CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUBUKOLA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMOLAFE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-542-3181
Mailing Address - Street 1:13838 S 46TH PL STE 300
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85044-7804
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:13838 S 46TH PL STE 300
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85044-7804
Practice Address - Country:US
Practice Address - Phone:832-542-3181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-14
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty