Provider Demographics
NPI:1689704173
Name:BETHESDA RESOURCES INC
Entity Type:Organization
Organization Name:BETHESDA RESOURCES INC
Other - Org Name:BETHESDA CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FINANCE
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:M
Authorized Official - Last Name:WEEKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-383-3325
Mailing Address - Street 1:505 W LOUISE AVE
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-1517
Mailing Address - Country:US
Mailing Address - Phone:256-383-3325
Mailing Address - Fax:256-383-5911
Practice Address - Street 1:1514 E UNION ST
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:MS
Practice Address - Zip Code:38703-3248
Practice Address - Country:US
Practice Address - Phone:662-332-6150
Practice Address - Fax:662-332-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-06
Last Update Date:2008-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS171372085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015886Medicaid