Provider Demographics
NPI:1003385055
Name:BETHSAIDA HEALTHCARE SYSTEM INC
Entity type:Organization
Organization Name:BETHSAIDA HEALTHCARE SYSTEM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FELIX
Authorized Official - Middle Name:C
Authorized Official - Last Name:AGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-753-2224
Mailing Address - Street 1:910 OLD CAMP RD STE 144
Mailing Address - Street 2:
Mailing Address - City:THE VILLAGES
Mailing Address - State:FL
Mailing Address - Zip Code:32162-5609
Mailing Address - Country:US
Mailing Address - Phone:352-753-2224
Mailing Address - Fax:353-753-0833
Practice Address - Street 1:910 OLD CAMP RD STE 144
Practice Address - Street 2:
Practice Address - City:THE VILLAGES
Practice Address - State:FL
Practice Address - Zip Code:32162-5609
Practice Address - Country:US
Practice Address - Phone:352-753-2224
Practice Address - Fax:353-753-0833
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-11-20
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207QA0505XAllopathic & Osteopathic PhysiciansFamily MedicineAdult MedicineGroup - Multi-Specialty
No2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty