Basic Information
| Provider Information | |||||||||
| NPI: | 1538129432 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TAU | ||||||||
| FirstName: | BETHANY | ||||||||
| MiddleName: | J | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1650 COCHRANE CIR ATTN: CREDENTIAL'S OFFICE | ||||||||
| Address2: | USA MEDDAC EVANS ARMY COMMUNITY HOSPITAL | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134604 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195267844 | ||||||||
| FaxNumber: | 7195267984 | ||||||||
| Practice Location | |||||||||
| Address1: | 1650 COCHRANE CIR | ||||||||
| Address2: | ORTHOPEDIC/PODIARTY CLINIC | ||||||||
| City: | FORT CARSON | ||||||||
| State: | CO | ||||||||
| PostalCode: | 809134606 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7195260721 | ||||||||
| FaxNumber: | 7195267856 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/24/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN-170464 | CO | Y | Nursing Service Providers | Registered Nurse |
No ID Information.