Healthcare Provider Details

I. General information

NPI: 1841481637
Provider Name (Legal Business Name): BETHANY MEDICAL CENTER, PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/06/2007
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 LYNDHURST AVE
WINSTON SALEM NC
27103-4007
US

IV. Provider business mailing address

3001 LYNDHURST AVE
WINSTON SALEM NC
27103-4007
US

V. Phone/Fax

Practice location:
  • Phone: 336-765-0383
  • Fax: 336-768-1737
Mailing address:
  • Phone: 336-765-0383
  • Fax: 336-768-1737

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: TAMMY FERRELL
Title or Position: ADMINISTRATOR
Credential:
Phone: 336-765-0383