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General NPI Number Information
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NPI Number | 1689704173
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Entity Type | Organization
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Legal Business Name | BETHESDA RESOURCES INC
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Dates
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Enumeration Date | 03/06/2007
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Last Update Date | 10/10/2008
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Provider Practice Location Address
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Address Line | 1514 E UNION ST
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City | GREENVILLE
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State | MS
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Zip | 38703-3248
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Country | US
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Telephone | 662-332-6150
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Fax | 662-332-4558
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Provider Business Mailing Address
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Address Line | 505 W LOUISE AVE
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City | MUSCLE SHOALS
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State | AL
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Zip | 35661-1517
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Country | US
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Telephone | 256-383-3325
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Fax | 256-383-5911
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Authorized Official
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Title or Position | VP FINANCE
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Name | CRAIG M WEEKS
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Credential |
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Telephone | 256-383-3325
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0001X
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Taxonomy Name | Radiation Oncology Physician
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License Number | 17137
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License Number State | MS
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