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General NPI Number Information
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NPI Number | 1922008440
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Entity Type | Individual
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Provider Name | VIDYA R BETHI MD
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Gender | Female
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Dates
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Enumeration Date | 07/27/2005
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Last Update Date | 12/14/2011
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Provider Practice Location Address
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Address Line | 482 WARFIELD BLVD
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City | CLARKSVILLE
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State | TN
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Zip | 37043-6071
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Country | US
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Telephone | 931-906-6644
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Fax | 931-906-7805
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Provider Business Mailing Address
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Address Line | 482 WARFIELD BLVD
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City | CLARKSVILLE
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State | TN
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Zip | 37043-6071
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Country | US
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Telephone | 931-906-6644
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Fax | 931-906-7805
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | MD0000027336
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD0000027336
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License Number State | TN
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