Healthcare Provider Details

I. General information

NPI: 1427024918
Provider Name (Legal Business Name): BETHESDA SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2006
Last Update Date: 12/23/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8175 BIG BEND BLVD SUITE 130
SAINT LOUIS MO
63119-3291
US

IV. Provider business mailing address

1630 DES PERES RD SUITE 290
SAINT LOUIS MO
63131-1800
US

V. Phone/Fax

Practice location:
  • Phone: 314-800-1900
  • Fax: 314-800-1961
Mailing address:
  • Phone: 314-800-1900
  • Fax: 314-800-1961

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. JOSEPH J BRINKER
Title or Position: EXECUTIVE VICE PRESIDENT
Credential:
Phone: 314-800-1986