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NPI Code Detail

MEDICARE: BETHEL HILLS INTEGRATED HEALTHCARE

MEDICARE: BETHEL HILLS INTEGRATED HEALTHCARE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1251S00000XCommunity/Behavioral Health Agency
2261Q00000XClinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
4261QM0850XAdult Mental Health Clinic/Center
5261QM0855XAdolescent and Children Mental Health Clinic/Center
6261QP2300XPrimary Care Clinic/Center
7363LP0808XPsychiatric/Mental Health Nurse Practitioner
8261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1215698642
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHEL HILLS INTEGRATED HEALTHCARE
Provider Business Mailing Address
First Line : 13838 S 46TH PL STE 340
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-7805
Country : US
Telephone Number : 480-597-7903
Fax Number : 480-597-7903
Provider Business Practice Location Address
First Line : 13838 S 46TH PL STE 340
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-7805
Country : US
Telephone Number : 480-597-7903
Fax Number : 480-597-7903
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : OLUBUKOLA KOMOLAFE
Credential : DNP
Telephone Number : 832-542-3181
Provider Enumeration Date : 01/07/2022
Last Update Date : 01/07/2022

Similar Medicare Providers

1134628738 — OLUBUKOLA KOMOLAFE NURSE PRACTITIONER
Practice Location Address:
13838 S 46TH PL STE 340
PHOENIX, AZ
85044-7805
Practice Phone: 832-542-3181
Practice Fax:
1578104154 — BETHEL HILLS CLINIC PLLC
Practice Location Address:
13838 S 46TH PL STE 340
PHOENIX, AZ
85044-7805
Practice Phone: 832-542-3181
Practice Fax:
1902491699 — BETHEL HILLS INTEGRATED HEALTHCARE PLLC
Practice Location Address:
13838 S 46TH PL STE 340
PHOENIX, AZ
85044-7805
Practice Phone: 832-542-3181
Practice Fax:
1174280549 — IBUKUN AJOKE FAGBUYI PMHNP
Practice Location Address:
13838 S 46TH PL STE 340
PHOENIX, AZ
85044-7805
Practice Phone: 480-597-7903
Practice Fax:
1962155739 — BETHEL HILLS INTEGRATED HEALTHCARE
Practice Location Address:
13838 S 46TH PL STE 340
PHOENIX, AZ
85044-7805
Practice Phone: 480-597-7903
Practice Fax: 480-597-7904
1033078894 — DR. KIMBERLY SWINSON-MOLLICA DPT
Practice Location Address:
1010 E BETH DR
PHOENIX, AZ
85042-7805
Practice Phone: 217-685-1457
Practice Fax:

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