Provider Demographics
NPI:1053027508
Name:BETHEL MEDICAL GROUP
Entity type:Organization
Organization Name:BETHEL MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NAOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:MADISTIN
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:561-420-3346
Mailing Address - Street 1:3950 S 57TH AVE
Mailing Address - Street 2:
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33463-4709
Mailing Address - Country:US
Mailing Address - Phone:561-433-9331
Mailing Address - Fax:561-433-8411
Practice Address - Street 1:6045 HAGEN RANCH RD STE 4
Practice Address - Street 2:
Practice Address - City:LAKE WORTH
Practice Address - State:FL
Practice Address - Zip Code:33467-7251
Practice Address - Country:US
Practice Address - Phone:561-433-9331
Practice Address - Fax:561-433-8411
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-27
Last Update Date:2025-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
No207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty