Healthcare Provider Details

I. General information

NPI: 1407244171
Provider Name (Legal Business Name): BETHESDA HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/05/2015
Last Update Date: 05/22/2023
Certification Date: 05/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15 STONEBRIDGE BLVD
JACKSON TN
38305-2042
US

IV. Provider business mailing address

15 STONEBRIDGE BLVD
JACKSON TN
38305-2042
US

V. Phone/Fax

Practice location:
  • Phone: 731-664-7949
  • Fax: 731-664-6141
Mailing address:
  • Phone: 731-664-7949
  • Fax: 731-664-6141

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN COLLIER
Title or Position: OWNER
Credential: MD
Phone: 731-664-7949