Provider Demographics
NPI:1225408925
Name:BETHESDA HOSP, INC.
Entity type:Organization
Organization Name:BETHESDA HOSP, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:AMBULATORY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:
Authorized Official - Last Name:KAES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:513-862-3550
Mailing Address - Street 1:3125 HAMILTON MASON RD
Mailing Address - Street 2:
Mailing Address - City:HAMILTON
Mailing Address - State:OH
Mailing Address - Zip Code:45011-5307
Mailing Address - Country:US
Mailing Address - Phone:513-893-8173
Mailing Address - Fax:513-893-8161
Practice Address - Street 1:3125 HAMILTON MASON RD
Practice Address - Street 2:
Practice Address - City:HAMILTON
Practice Address - State:OH
Practice Address - Zip Code:45011-5307
Practice Address - Country:US
Practice Address - Phone:513-893-8173
Practice Address - Fax:513-893-8161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-07
Last Update Date:2015-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH022192600-033336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2154474OtherPK