Healthcare Provider Details

I. General information

NPI: 1215407879
Provider Name (Legal Business Name): BETH R BILLIPS CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/27/2018
Last Update Date: 11/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 MCDONALD PIKE
PAULDING OH
45879
US

IV. Provider business mailing address

501 MCDONALD PIKE PO BOX 329
PAULDING OH
45879
US

V. Phone/Fax

Practice location:
  • Phone: 419-399-3636
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberCDCA.164303
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: