Provider Demographics
NPI:1891846937
Name:VILLAGE OF BETHESDA
Entity type:Organization
Organization Name:VILLAGE OF BETHESDA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:FISCAL OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:RICKY
Authorized Official - Middle Name:W
Authorized Official - Last Name:BURKHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-484-1250
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:OH
Mailing Address - Zip Code:43719-0591
Mailing Address - Country:US
Mailing Address - Phone:740-484-4573
Mailing Address - Fax:740-484-4575
Practice Address - Street 1:103 EAST SPRING STREET
Practice Address - Street 2:
Practice Address - City:BETHESDA
Practice Address - State:OH
Practice Address - Zip Code:43719
Practice Address - Country:US
Practice Address - Phone:740-484-4573
Practice Address - Fax:740-484-4575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-16
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH020323950OtherBOARD OF PHARMACY
OH2149222Medicaid
OH590013463OtherMEDICARE RR
OH000000154984OtherBCBS
OH590013463OtherMEDICARE RR
OH9303131Medicare PIN