=====================================================
General NPI Number Information
=====================================================
NPI Number | 1306070990
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BETHEL MEDICAL EQUIPMENT & SUPPLIES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/11/2009
-----------------------------------------------------
Last Update Date | 05/05/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4741 ARMOUR RD SUITE A
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-5093
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-576-9999
-----------------------------------------------------
Fax | 706-576-9988
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1536 RIDGE CREEK WAY
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | GA
-----------------------------------------------------
Zip | 31904-1363
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 706-576-9999
-----------------------------------------------------
Fax | 706-576-9988
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. COLLINS ONUKWUE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 706-576-9999
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 335E00000X
-----------------------------------------------------
Taxonomy Name | Prosthetic/Orthotic Supplier
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 332B00000X
-----------------------------------------------------
Taxonomy Name | Durable Medical Equipment & Medical Supplies
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------