Provider Demographics
NPI:1023093234
Name:BETHESDA HOSPITAL INC.
Entity type:Organization
Organization Name:BETHESDA HOSPITAL INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JARED
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-737-7733
Mailing Address - Street 1:2815 S SEACREST BLVD
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-7934
Mailing Address - Country:US
Mailing Address - Phone:561-737-7733
Mailing Address - Fax:561-737-4534
Practice Address - Street 1:2815 S SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-7934
Practice Address - Country:US
Practice Address - Phone:561-737-7733
Practice Address - Fax:561-737-4534
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA HOSPITAL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-12-09
Last Update Date:2023-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL4452283X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283X00000XHospitalsRehabilitation Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL010140100Medicaid
10T002Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER