1538356324 NPI number — BENJAMIN ENTERPRISES, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538356324 NPI number — BENJAMIN ENTERPRISES, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENJAMIN ENTERPRISES, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538356324
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1801 DOUG BAKER BLVD STE 115
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOOVER
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
35242-4958
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
205-536-7758
Provider Business Mailing Address Fax Number:
205-536-7759

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1801 DOUG BAKER BLVD STE 115
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
HOOVER
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
35242-4958
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
205-536-7758
Provider Business Practice Location Address Fax Number:
205-536-7759
Provider Enumeration Date:
09/26/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
BENJAMIN
Authorized Official Middle Name:
WILSON
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
205-536-7758

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  2096 , 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)

  • Identifier: 668275 . This is a "ACN" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 7002756 . This is a "AETNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 7952010 . This is a "CIGNA" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 0083035 . This is a "HEALTHSPRING" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 51542691 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com