MEDICARE: BETHESDA RESOURCES INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	2085R0001X	Radiation Oncology Physician	17137	MS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1689704173
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA RESOURCES INC

Provider Business Mailing Address
First Line	:	505 W LOUISE AVE
Second Line	:
City	:	MUSCLE SHOALS
State	:	AL
Zip	:	35661-1517
Country	:	US
Telephone Number	:	256-383-3325
Fax Number	:	256-383-5911

Provider Business Practice Location Address
First Line	:	1514 E UNION ST
Second Line	:
City	:	GREENVILLE
State	:	MS
Zip	:	38703-3248
Country	:	US
Telephone Number	:	662-332-6150
Fax Number	:	662-332-4558

Authorized Official
Title or Position	:	VP FINANCE
Name	:	CRAIG M WEEKS
Credential	:
Telephone Number	:	256-383-3325

Provider Enumeration Date	:	03/06/2007
Last Update Date	:	10/10/2008

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Directions to “BETHESDA RESOURCES INC ” Practice Location

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