MEDICARE: BETHESDA HOSPITAL INC

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	333600000X	Pharmacy
2	3336S0011X	Specialty Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2176983	OTHER		PK

General Provider Information

NPI Number	:	1457858201
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHESDA HOSPITAL INC

Provider Business Mailing Address
First Line	:	2001 ANDERSON FERRY RD
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45238-3325
Country	:	US
Telephone Number	:	513-246-5675
Fax Number	:

Provider Business Practice Location Address
First Line	:	4623 WESLEY AVE STE N
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45212-2272
Country	:	US
Telephone Number	:	877-403-4229
Fax Number	:	513-246-5676

Authorized Official
Title or Position	:	PHARMACY MANAGER
Name	:	JOHN REILLY
Credential	:
Telephone Number	:	513-246-5676

Provider Enumeration Date	:	04/09/2018
Last Update Date	:	04/25/2018

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