MEDICARE: MT BETHEL MEDICAL CENTER LLC

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	207R00000X	Internal Medicine Physician	MD053686L	PA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	110130795	OTHER		PALMETTO GBA - RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
2	50017380	OTHER	CAPITAL BLUE CROSS
3	1512446	OTHER	HIGHMARK BLUE SHIELD
4	5843921	OTHER	CIGNA

General Provider Information

NPI Number	:	1992729503
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MT BETHEL MEDICAL CENTER LLC

Provider Business Mailing Address
First Line	:	PO BOX 43
Second Line	:	10 MOUNT BETHEL PLAZA
City	:	MOUNT BETHEL
State	:	PA
Zip	:	18343-0043
Country	:	US
Telephone Number	:	570-897-7559
Fax Number	:	570-897-7567

Provider Business Practice Location Address
First Line	:	10 MOUNT BETHEL PLZ
Second Line	:
City	:	MOUNT BETHEL
State	:	PA
Zip	:	18343-5212
Country	:	US
Telephone Number	:	570-897-7559
Fax Number	:	570-897-7567

Authorized Official
Title or Position	:	CEO MOUNT BETHEL MEDICAL CENTER LLC
Name	:	DR. JON A RASO
Credential	:	MD
Telephone Number	:	570-897-7559

Provider Enumeration Date	:	07/27/2006
Last Update Date	:	02/19/2009

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Directions to “MT BETHEL MEDICAL CENTER LLC ” Practice Location

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