Provider Demographics
NPI:1154342129
Name:BETHESDA HOSPITAL INC
Entity type:Organization
Organization Name:BETHESDA HOSPITAL INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF SENIOR LINK
Authorized Official - Prefix:MR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:KIRKPATRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-612-8430
Mailing Address - Street 1:4750 WESLEY AVE
Mailing Address - Street 2:SUITE J
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45212-2276
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4750 WESLEY AVE
Practice Address - Street 2:SUITE J
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45212-2276
Practice Address - Country:US
Practice Address - Phone:513-531-5110
Practice Address - Fax:513-569-5199
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BETHESDA HOSPITAL INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-22
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH021344000333600000X
3336C0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0002XSuppliersPharmacyClinic Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
3674391OtherOTHER ID NUMBER-COMMERCIAL NUMBER
OH0278837Medicaid
H3614Medicare ID - Type Unspecified