1558459933 NPI number — GEORGE RUFFIN BENTON III M.D.

Table of content: GEORGE RUFFIN BENTON III M.D. (NPI 1558459933)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558459933 NPI number — GEORGE RUFFIN BENTON III M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENTON
Provider First Name:
GEORGE
Provider Middle Name:
RUFFIN
Provider Name Prefix Text:
Provider Name Suffix Text:
III
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
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:
1558459933
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/07/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
220 5TH AVE E
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSONVILLE
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28792-4377
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-692-4289
Provider Business Mailing Address Fax Number:
828-696-1794

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29 W FRENCH BROAD ST STE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BREVARD
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28712-4773
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
828-883-5550
Provider Business Practice Location Address Fax Number:
828-883-5525
Provider Enumeration Date:
10/10/2006

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: 207Q00000X , with the licence number:  18605 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 01-70389 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 15071 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 8915071 , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 561852981E . This is a "CIGNA" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 0637660001 . This is a "PALMETTO GOVERNMENT SERVI" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 110012027 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".




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