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NPI Code Detail

MEDICARE: BETHEL HILLS INTEGRATED HEALTHCARE PLLC

MEDICARE: BETHEL HILLS INTEGRATED HEALTHCARE 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
1363LP2300XPrimary Care Nurse Practitioner
2363LP0808XPsychiatric/Mental Health Nurse Practitioner

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1902491699
Entity Type Code : Organization
Provider Name (Legal Business Name) : BETHEL HILLS INTEGRATED HEALTHCARE PLLC
Provider Business Mailing 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 :
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 : DNP, PMHNP-BC, FNP-B
Telephone Number : 832-542-3181
Provider Enumeration Date : 03/04/2021
Last Update Date : 02/14/2022

Similar Medicare Providers

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Practice Location Address:
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PHOENIX, AZ
85044-7805
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85044-7805
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1215698642 — BETHEL HILLS INTEGRATED HEALTHCARE
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PHOENIX, AZ
85044-7805
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1962155739 — BETHEL HILLS INTEGRATED HEALTHCARE
Practice Location Address:
13838 S 46TH PL STE 340
PHOENIX, AZ
85044-7805
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Practice Fax: 480-597-7904
1033078894 — DR. KIMBERLY SWINSON-MOLLICA DPT
Practice Location Address:
1010 E BETH DR
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85042-7805
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Practice Fax:

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