Provider Demographics
NPI:1871473926
Name:BETA AND BLOOM LLC
Entity type:Organization
Organization Name:BETA AND BLOOM LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHELSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PETRIE
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:405-326-4152
Mailing Address - Street 1:3695 SIENNA RDG
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:OK
Mailing Address - Zip Code:73065-0019
Mailing Address - Country:US
Mailing Address - Phone:405-936-0504
Mailing Address - Fax:405-936-0561
Practice Address - Street 1:3695 SIENNA RDG
Practice Address - Street 2:
Practice Address - City:NEWCASTLE
Practice Address - State:OK
Practice Address - Zip Code:73065-0019
Practice Address - Country:US
Practice Address - Phone:405-936-0504
Practice Address - Fax:405-936-0561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-09-08
Last Update Date:2025-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Single Specialty