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NPI Code Detail

MEDICARE: BETHEL HILLS CLINIC PLLC

MEDICARE: BETHEL HILLS CLINIC PLLC
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
1251S00000XCommunity/Behavioral Health Agency
2261Q00000XClinic/Center
3261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)
4261QM0850XAdult Mental Health Clinic/Center
5261QM0855XAdolescent and Children Mental Health Clinic/Center
6261QP2300XPrimary Care Clinic/Center
7363LP0808XPsychiatric/Mental Health Nurse Practitioner
8261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1578104154
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHEL HILLS CLINIC PLLC
Provider Business Mailing Address
First Line : PO BOX 2251
Second Line :
City : SCOTTSDALE
State : AZ
Zip : 85252-2251
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 13838 S 46TH PL STE 340
Second Line :
City : PHOENIX
State : AZ
Zip : 85044-7805
Country : US
Telephone Number : 832-542-3181
Fax Number :
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : OLUBUKOLA KOMOLAFE
Credential :
Telephone Number : 832-542-3181
Provider Enumeration Date : 10/04/2019
Last Update Date : 03/29/2022

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