MEDICARE: BETHESDA

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	314000000X	Skilled Nursing Facility	327806	MN

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	8658BE	OTHER	MN	BLUE PLUS & BCBS

General Provider Information

NPI Number	:	1427050525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA

Provider Business Mailing Address
First Line	:	1012 3RD ST SE
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-4554
Country	:	US
Telephone Number	:	320-235-3924
Fax Number	:	320-231-3399

Provider Business Practice Location Address
First Line	:	1012 3RD ST SE
Second Line	:
City	:	WILLMAR
State	:	MN
Zip	:	56201-4554
Country	:	US
Telephone Number	:	320-235-3924
Fax Number	:	320-231-3399

Authorized Official
Title or Position	:	OFFICE MANAGER
Name	:	MRS. ALANA SUE ZIEHL
Credential	:
Telephone Number	:	320-235-9532

Provider Enumeration Date	:	06/02/2005
Last Update Date	:	10/24/2011

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Directions to “BETHESDA ” Practice Location

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