| Bethel Hills Clinic Pllc | |
|
13838 S 46th Pl Ste 340 Phoenix AZ 85044-7805 | |
| (832) 542-3181 | |
| Not Available |
| Full Name | Bethel Hills Clinic Pllc |
|---|---|
| Speciality | Clinic/Center |
| Location | 13838 S 46th Pl Ste 340, Phoenix, Arizona |
| Authorized Official Name and Position | Olubukola Komolafe (MEDICAL DIRECTOR) |
| Authorized Official Contact | 8325423181 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Bethel Hills Clinic Pllc Po Box 2251 Scottsdale AZ 85252-2251 Ph: () - | Bethel Hills Clinic Pllc 13838 S 46th Pl Ste 340 Phoenix AZ 85044-7805 Ph: (832) 542-3181 |
| NPI Number | 1578104154 |
|---|---|
| Provider Enumeration Date | 10/04/2019 |
| Last Update Date | 03/29/2022 |
| Certification Date | 03/29/2022 |
| Medicare PECOS PAC ID | 3173951670 |
|---|---|
| Medicare Enrollment ID | O20200316002710 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1578104154 | NPI | - | NPPES |
| Provider Name | Olubukola Komolafe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1134628738 PECOS PAC ID: 7315200227 Enrollment ID: I20180405002599 |
| Provider Name | Daud Biola Koleosho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1962093781 PECOS PAC ID: 4880001544 Enrollment ID: I20210324001387 |
| Provider Name | Sheeba Kalappurakkal Divakaran |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1174120489 PECOS PAC ID: 7012326804 Enrollment ID: I20210506003094 |
| Provider Name | Mispa Ewube Nkongho |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1083389662 PECOS PAC ID: 3274922497 Enrollment ID: I20211109003392 |
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