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General NPI Number Information
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NPI Number | 1467829663
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Entity Type | Organization
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Legal Business Name | BETHANY MEDICAL CENTER
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Dates
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Enumeration Date | 08/24/2015
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Last Update Date | 10/13/2025
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Provider Practice Location Address
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Address Line | 575 N PATTERSON AVE SUITE 440
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City | WINSTON SALEM
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State | NC
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Zip | 27101-4101
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Country | US
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Telephone | 877-722-8910
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Fax |
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Provider Business Mailing Address
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Address Line | 507 N LINDSAY ST
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City | HIGH POINT
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State | NC
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Zip | 27262-4303
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Country | US
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Telephone | 336-883-0029
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Fax | 336-899-2188
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | LENIN J PETERS
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Credential | MD
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Telephone | 336-883-0029
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 291U00000X
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Taxonomy Name | Clinical Medical Laboratory
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License Number | 34D2089959
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License Number State | NC
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