MEDICARE: BETHEL CLINIC & URGENT CARE

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	261Q00000X	Clinic/Center
2	261QP2300X	Primary Care Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1346958766	OTHER	IL	PRACTICE NPI

General Provider Information

NPI Number	:	1346958766
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHEL CLINIC & URGENT CARE

Provider Business Mailing Address
First Line	:	1705 E SAUK TRL
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-4955
Country	:	US
Telephone Number	:	708-506-3188
Fax Number	:

Provider Business Practice Location Address
First Line	:	1705 E SAUK TRL
Second Line	:
City	:	SAUK VILLAGE
State	:	IL
Zip	:	60411-4955
Country	:	US
Telephone Number	:	708-506-3188
Fax Number	:	815-205-4821

Authorized Official
Title or Position	:	MANAGER
Name	:	MR. CHUKS B AKAEZE
Credential	:	RN/BSN
Telephone Number	:	708-506-3188

Provider Enumeration Date	:	11/15/2022
Last Update Date	:	02/25/2024

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