MEDICARE: BETHANY J TAU

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	163W00000X	Registered Nurse	RN-170464	CO

General Provider Information

NPI Number	:	1538129432
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BETHANY J TAU

Provider Business Mailing Address
First Line	:	1650 COCHRANE CIR ATTN: CREDENTIAL'S OFFICE
Second Line	:	USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4604
Country	:	US
Telephone Number	:	719-526-7844
Fax Number	:	719-526-7984

Provider Business Practice Location Address
First Line	:	1650 COCHRANE CIR
Second Line	:	ORTHOPEDIC/PODIARTY CLINIC
City	:	FORT CARSON
State	:	CO
Zip	:	80913-4606
Country	:	US
Telephone Number	:	719-526-0721
Fax Number	:	719-526-7856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/24/2006
Last Update Date	:	07/08/2007

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