Provider Demographics
NPI:1063680973
Name:BENTON NEUROCARE INC.
Entity Type:Organization
Organization Name:BENTON NEUROCARE INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AHMAD
Authorized Official - Middle Name:
Authorized Official - Last Name:AL-KHATIB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:479-254-9761
Mailing Address - Street 1:811 SE 28TH ST STE 5
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-4294
Mailing Address - Country:US
Mailing Address - Phone:479-254-9761
Mailing Address - Fax:479-254-9732
Practice Address - Street 1:811 SE 28TH ST STE 5
Practice Address - Street 2:
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-4294
Practice Address - Country:US
Practice Address - Phone:479-254-9761
Practice Address - Fax:479-254-9732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-13
Last Update Date:2008-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center