Provider Demographics
NPI:1285914051
Name:BETHEL UNIVERSTIY
Entity type:Organization
Organization Name:BETHEL UNIVERSTIY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:TY
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:731-415-2701
Mailing Address - Street 1:325 CHERRY AVE # 335
Mailing Address - Street 2:
Mailing Address - City:MC KENZIE
Mailing Address - State:TN
Mailing Address - Zip Code:38201-1769
Mailing Address - Country:US
Mailing Address - Phone:731-352-4000
Mailing Address - Fax:731-352-4238
Practice Address - Street 1:325 CHERRY AVE # 335
Practice Address - Street 2:
Practice Address - City:MC KENZIE
Practice Address - State:TN
Practice Address - Zip Code:38201-1769
Practice Address - Country:US
Practice Address - Phone:731-352-4000
Practice Address - Fax:731-352-4238
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-24
Last Update Date:2011-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS1000XAmbulatory Health Care FacilitiesClinic/CenterStudent Health