Bethany Medical Clinic, LLC
Organization Active NPI Family Nurse Practitioner · Cleveland, MS
NPI 1487792032 · NPPES record last updated Mar 9, 2010
Key facts
- NPI
- 1487792032
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- R793654 (MS)
- Legal business name
- BETHANY MEDICAL CLINIC, LLC
- Practice address
- 548 East Rosemary Road
Suite B
Cleveland, MS 38732 - Phone
- (662) 846-5032
- Fax
- (662) 846-5034
- NPI assigned
- Feb 2, 2007
- Organization subpart
- No
Authorized official
- Name
- Mr. Ricky Moore
- Title
- Ins. Clerk
- Phone
- (662) 846-5032
Practitioners 1
National Provider Directory
Locations
548 Rosemary Rd
Ste B
Cleveland, MS 38732
Phone (662) 846-5032
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner |
363LF0000X | R793654 | MS | Yes |
Addresses
Primary practice location
548 East Rosemary Road
Suite B
Cleveland, MS 38732
Mailing address
PO Box 358
Cleveland, MS 38732-0358
Phone (662) 846-5032
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 07021837 | Medicaid | MS |
Other providers in Cleveland, MS
- Jackie Barnes
- Bradley Rex Baugh
- Matthew Bear
- Berry Chiropractic Family and Sports Rehabilitation Center, LLC
- Bethany Medical Clinic
- Tracy Marie Blackstock
- Don Blackwood
- Mark Edward Blackwood
- Blake Surgical Association PLLC
- Roger Alan Blake
All providers in Cleveland, MS · Family Nurse Practitioner in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Mar 9, 2010. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.