Healthcare Provider Details

I. General information

NPI: 1073768099
Provider Name (Legal Business Name): BETHESDA HEALTHCARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/18/2008
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4452 EASTGATE BLVD SUITE 101
CINCINNATI OH
45245-1584
US

IV. Provider business mailing address

PO BOX 630185
CINCINNATI OH
45263-0185
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-3695
  • Fax: 513-752-3039
Mailing address:
  • Phone: 513-891-7230
  • Fax: 513-891-7354

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. PAMELA SHANNON
Title or Position: VICE PRESIDENT
Credential:
Phone: 513-977-0005