Provider Demographics
NPI:1568940708
Name:OHEIM, BENJAMIN (AGCNS-BC)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:
Last Name:OHEIM
Suffix:
Gender:M
Credentials:AGCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7016 RAZORS EDGE DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-3332
Mailing Address - Country:US
Mailing Address - Phone:806-570-7848
Mailing Address - Fax:
Practice Address - Street 1:3000 N INTERSTATE 35 STE 700
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78705-1852
Practice Address - Country:US
Practice Address - Phone:512-807-3150
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-31
Last Update Date:2018-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX881724163W00000X
TXAP138289364SG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SG0600XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistGerontology
No163W00000XNursing Service ProvidersRegistered Nurse