Provider Demographics
NPI:1568838944
Name:BENTZCO LLC
Entity Type:Organization
Organization Name:BENTZCO LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINIC ADMINISTRATOR/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:RHONDA
Authorized Official - Middle Name:K
Authorized Official - Last Name:BENTZ
Authorized Official - Suffix:
Authorized Official - Credentials:CFNP
Authorized Official - Phone:505-890-2185
Mailing Address - Street 1:5 HIGHWAY 474
Mailing Address - Street 2:
Mailing Address - City:ALGODONES
Mailing Address - State:NM
Mailing Address - Zip Code:87001-8028
Mailing Address - Country:US
Mailing Address - Phone:505-818-8588
Mailing Address - Fax:505-890-2168
Practice Address - Street 1:3777 THE AMERICAN RD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87114-1338
Practice Address - Country:US
Practice Address - Phone:505-890-2185
Practice Address - Fax:505-890-2168
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-08-19
Last Update Date:2015-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP00238363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty