Provider Demographics
NPI:1245473313
Name:BETHEL INTERNAL MEDICINE AND PEDIATRICS LLC
Entity type:Organization
Organization Name:BETHEL INTERNAL MEDICINE AND PEDIATRICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CURTIS
Authorized Official - Middle Name:B
Authorized Official - Last Name:EVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:513-734-9200
Mailing Address - Street 1:PO BOX 713013
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43271-3013
Mailing Address - Country:US
Mailing Address - Phone:513-734-9200
Mailing Address - Fax:513-734-9300
Practice Address - Street 1:720 W PLANE ST
Practice Address - Street 2:
Practice Address - City:BETHEL
Practice Address - State:OH
Practice Address - Zip Code:45106-8339
Practice Address - Country:US
Practice Address - Phone:513-734-9200
Practice Address - Fax:513-734-9300
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-20
Last Update Date:2011-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2944587Medicaid
DP7944OtherRR MEDICARE
OH2944587Medicaid