1871711705 NPI number — MRS. IVETT HABER BENSINGER OTR

Table of content: MRS. IVETT HABER BENSINGER OTR (NPI 1871711705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1871711705 NPI number — MRS. IVETT HABER BENSINGER OTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENSINGER
Provider First Name:
IVETT
Provider Middle Name:
HABER
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OTR
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
HABER
Provider Other First Name:
IVETT
Provider Other Middle Name:
MARIA
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
OTR
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1871711705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/09/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 S HILLCREST BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TROY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36081-1630
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-672-4060
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
100 S HILLCREST BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TROY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36081-1630
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-672-4060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/23/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 225XP0200X , with the licence number:  1509 , registered in the state of AL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)