Healthcare Provider Details

I. General information

NPI: 1851496863
Provider Name (Legal Business Name): BETHANY MEDICAL RURAL HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3202 MILLER ST
BETHANY MO
64424-2713
US

IV. Provider business mailing address

3202 MILLER ST
BETHANY MO
64424-2713
US

V. Phone/Fax

Practice location:
  • Phone: 660-425-3154
  • Fax: 660-425-6663
Mailing address:
  • Phone: 660-425-3154
  • Fax: 660-425-6663

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License NumberR8C23
License Number StateMO

VIII. Authorized Official

Name: DR. NATU B PATEL
Title or Position: PHYSICIAN/OWNER
Credential: MD
Phone: 660-425-3154