Provider Demographics
NPI:1265611743
Name:BETHANN MAHONEY PC
Entity type:Organization
Organization Name:BETHANN MAHONEY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BETHANN
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHONEY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:520-797-3077
Mailing Address - Street 1:6812 N ORACLE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85704-4246
Mailing Address - Country:US
Mailing Address - Phone:520-797-3077
Mailing Address - Fax:520-742-0050
Practice Address - Street 1:6812 N ORACLE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85704-4246
Practice Address - Country:US
Practice Address - Phone:520-797-3077
Practice Address - Fax:520-742-0050
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ34362084P0802X, 2084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No2084P0802XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction PsychiatryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ101194Medicare PIN