Provider Demographics
NPI:1124061494
Name:BETHESDA FAMILY PRACTICE CENTER
Entity type:Organization
Organization Name:BETHESDA FAMILY PRACTICE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:ESTEP
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-977-6715
Mailing Address - Street 1:1775 W LEXINGTON STE 100
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-3667
Mailing Address - Country:US
Mailing Address - Phone:513-977-6700
Mailing Address - Fax:513-531-2624
Practice Address - Street 1:1775 W LEXINGTON STE 100
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-3667
Practice Address - Country:US
Practice Address - Phone:513-977-6700
Practice Address - Fax:513-531-2624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-14
Last Update Date:2018-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0687529Medicaid
OH0687529Medicaid