Provider Demographics
NPI:1962685040
Name:JOHN C BETANCOURT MD PLLC
Entity Type:Organization
Organization Name:JOHN C BETANCOURT MD PLLC
Other - Org Name:HILLTOP FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:CLEMENTS
Authorized Official - Last Name:BETANCOURT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:828-874-4600
Mailing Address - Street 1:PO BOX 70
Mailing Address - Street 2:
Mailing Address - City:RUTHERFORD COLLEGE
Mailing Address - State:NC
Mailing Address - Zip Code:28671-0070
Mailing Address - Country:US
Mailing Address - Phone:828-874-4600
Mailing Address - Fax:828-874-8900
Practice Address - Street 1:720 MALCOLM BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:VALDESE
Practice Address - State:NC
Practice Address - Zip Code:28690-2872
Practice Address - Country:US
Practice Address - Phone:828-874-4600
Practice Address - Fax:828-874-8900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-11
Last Update Date:2008-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC891134YMedicaid
NC2345686Medicare PIN
NC891134YMedicaid