MEDICARE: BETTY'S HEALTH COMPANY, LLC

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
1	207VG0400X	Gynecology Physician

General Provider Information

NPI Number	:	1306430863
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETTY'S HEALTH COMPANY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 692167
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78269-2167
Country	:	US
Telephone Number	:	615-720-5153
Fax Number	:

Provider Business Practice Location Address
First Line	:	1511 MALLARD HVN
Second Line	:
City	:	SAN ANTONIO
State	:	TX
Zip	:	78260-4208
Country	:	US
Telephone Number	:	615-720-5153
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER & CEO
Name	:	JENNIFER NEWELL
Credential	:
Telephone Number	:	615-720-5153

Provider Enumeration Date	:	02/25/2021
Last Update Date	:	03/03/2021

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