Provider Demographics
NPI:1780187294
Name:MYBETHONY ENTERPRISES
Entity Type:Organization
Organization Name:MYBETHONY ENTERPRISES
Other - Org Name:ALLURING FOOTWEAR
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MERWYN
Authorized Official - Middle Name:
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:601-896-3092
Mailing Address - Street 1:3027 AUTUMN PL S APT A
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39212-2419
Mailing Address - Country:US
Mailing Address - Phone:601-896-3092
Mailing Address - Fax:
Practice Address - Street 1:3027 AUTUMN PL S APT A
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39212-2419
Practice Address - Country:US
Practice Address - Phone:601-896-3092
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MYBETHONY ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-03-10
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment