MEDICARE: BETHANY WOMENS HEALTHCARE, P.C.

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	261QB0400X	Birthing Clinic/Center	OTC0777	AZ

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AZ0203330	OTHER	AZ	BLUE CROSS BLUE SHIELD
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	621484	OTHER	AZ	AETNA

General Provider Information

NPI Number	:	1811091929
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BETHANY WOMENS HEALTHCARE, P.C.

Provider Business Mailing Address
First Line	:	3660 W BETHANY HOME RD
Second Line	:	SUITE B
City	:	PHOENIX
State	:	AZ
Zip	:	85019-1953
Country	:	US
Telephone Number	:	602-973-3200
Fax Number	:	602-973-0508

Provider Business Practice Location Address
First Line	:	3660 W BETHANY HOME RD
Second Line	:	SUITE B
City	:	PHOENIX
State	:	AZ
Zip	:	85019-1953
Country	:	US
Telephone Number	:	602-973-3200
Fax Number	:	602-973-0508

Authorized Official
Title or Position	:	PRACTICE ADMINISTRATOR
Name	:	SHEILA CASEBOLT
Credential	:	CCS-P
Telephone Number	:	602-973-3200

Provider Enumeration Date	:	09/11/2006
Last Update Date	:	08/22/2020

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