Healthcare Provider Details

I. General information

NPI: 1164596326
Provider Name (Legal Business Name): BETHESDA CARE EASTGATE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2006
Last Update Date: 08/22/2020
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

10185 WATERSIDE CT
UNION KY
41091-9489
US

V. Phone/Fax

Practice location:
  • Phone: 513-752-3695
  • Fax: 513-752-3039
Mailing address:
  • Phone: 859-384-7221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0100X
TaxonomyOccupational Medicine Clinic/Center
License Number35071748
License Number StateOH

VIII. Authorized Official

Name: CHUC PHUC LE
Title or Position: FACILITY MEDICAL DIRECTOR
Credential: M.D.
Phone: 513-752-3695