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General NPI Number Information
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NPI Number | 1508993866
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Entity Type | Organization
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Legal Business Name | BETHAMY ENTERPRISES INC.
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Dates
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Enumeration Date | 02/27/2007
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Last Update Date | 07/31/2008
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Provider Practice Location Address
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Address Line | 909 N SALISBURY AVE
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City | SPENCER
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State | NC
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Zip | 28159-1828
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Country | US
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Telephone | 704-633-1985
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Fax |
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Provider Business Mailing Address
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Address Line | 909 N SALISBURY AVE
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City | SPENCER
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State | NC
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Zip | 28159-1828
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. SUSAN LANE MORRIS
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Credential |
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Telephone | 704-633-1985
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302F00000X
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Taxonomy Name | Exclusive Provider Organization
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License Number | HAL080-006
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License Number State | NC
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