Healthcare Provider Details

I. General information

NPI: 1659996544
Provider Name (Legal Business Name): BETHESDA MEDICAL CLINIC INFUSION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/16/2020
Last Update Date: 08/05/2020
Certification Date: 08/05/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1620 BELLE CHASSE HWY STE 102
TERRYTOWN LA
70056-7057
US

IV. Provider business mailing address

1620 BELLE CHASSE HWY STE 102
TERRYTOWN LA
70056-7057
US

V. Phone/Fax

Practice location:
  • Phone: 504-265-8301
  • Fax: 504-309-4193
Mailing address:
  • Phone: 504-265-8301
  • Fax: 504-309-4193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QI0500X
TaxonomyInfusion Therapy Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. SHIBU VARUGHESE
Title or Position: MEMBER
Credential: MD
Phone: 504-265-8304