Bethel Medical Center, PLLC

Primary specialty

Clinic/CenterTaxonomy code 261Q00000X

Legal business name

BETHEL MEDICAL CENTER, PLLC

Practice address

3535 N Buckner Blvd Ste 104
Dallas, TX 75228-5548

Phone

(214) 774-9111

Fax

(214) 774-9109

NPI assigned

Sep 23, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Michael Emeka Esedebe

Title

MD

Phone

(214) 774-9111

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1632355200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1680739200000",
    "number": "1174294656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3535 N BUCKNER BLVD STE 104",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752285548",
            "telephone_number": "214-774-9111",
            "fax_number": "214-774-9109"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3535 N BUCKNER BLVD STE 104",
            "city": "DALLAS",
            "state": "TX",
            "postal_code": "752285548",
            "telephone_number": "214-774-9111",
            "fax_number": "214-774-9109"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BETHEL MEDICAL CENTER, PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-09-23",
        "last_updated": "2023-04-06",
        "certification_date": "2023-04-06",
        "status": "A",
        "authorized_official_last_name": "ESEDEBE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "EMEKA",
        "authorized_official_title_or_position": "MD",
        "authorized_official_telephone_number": "214-774-9111"
    },
    "taxonomies": [
        {
            "code": "261Q00000X",
            "taxonomy_group": "",
            "desc": "Clinic/Center",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Clinic/Center in Dallas, TX
• Providers in Dallas, TX by specialty
• Clinic/Center in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 6, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.