1487990495 NPI number — BETHESDA MEDICARE SERVICES LTD

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1487990495 NPI number — BETHESDA MEDICARE SERVICES LTD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BETHESDA MEDICARE SERVICES LTD
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1487990495
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/02/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
990 GRAND CANYON PKWY
Provider Second Line Business Mailing Address:
SUITE 418
Provider Business Mailing Address City Name:
HOFFMAN ESTATES
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60169-1739
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
331-472-8802
Provider Business Mailing Address Fax Number:
331-472-8803

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
990 GRAND CANYON PKWY
Provider Second Line Business Practice Location Address:
SUITE 418
Provider Business Practice Location Address City Name:
HOFFMAN ESTATES
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60169-1737
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
331-472-8802
Provider Business Practice Location Address Fax Number:
331-472-8803
Provider Enumeration Date:
12/19/2012

Additional Information

Authorized Official

Authorized Official Last Name:
KRISHNA
Authorized Official First Name:
MEENA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
331-472-8802

Provider Taxonomy Codes

  • Taxonomy code: 207R00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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