Provider Demographics
NPI:1568797975
Name:BENCHMARK ATLANTIC HEALTHCARE
Entity Type:Organization
Organization Name:BENCHMARK ATLANTIC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:CATHERINE
Authorized Official - Middle Name:MARY
Authorized Official - Last Name:BOLL
Authorized Official - Suffix:
Authorized Official - Credentials:CMF
Authorized Official - Phone:815-578-0304
Mailing Address - Street 1:93 WEST GENEVA STREET
Mailing Address - Street 2:
Mailing Address - City:WILLIAMS BAY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-578-0304
Mailing Address - Fax:815-578-0343
Practice Address - Street 1:93 W GENEVA ST
Practice Address - Street 2:
Practice Address - City:WILLIAMS BAY
Practice Address - State:WI
Practice Address - Zip Code:53191-9518
Practice Address - Country:US
Practice Address - Phone:262-245-0305
Practice Address - Fax:815-578-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-03
Last Update Date:2010-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI4480660002Medicare NSC