Healthcare Provider Details

I. General information

NPI: 1508459306
Provider Name (Legal Business Name): BETHANY MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2021
Last Update Date: 10/13/2025
Certification Date: 10/13/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

819 N MAIN ST STE 112
HIGH POINT NC
27262-3996
US

IV. Provider business mailing address

507 N LINDSAY ST
HIGH POINT NC
27262-4303
US

V. Phone/Fax

Practice location:
  • Phone: 336-883-0029
  • Fax:
Mailing address:
  • Phone: 336-883-0029
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LENIN J PETERS
Title or Position: CEO
Credential: MD
Phone: 336-883-0029