Provider Demographics
NPI:1740596527
Name:BENDER MEDICAL GROUP
Entity Type:Organization
Organization Name:BENDER MEDICAL GROUP
Other - Org Name:MIRAMONT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERESA
Authorized Official - Middle Name:
Authorized Official - Last Name:BENDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-482-0213
Mailing Address - Street 1:4674 SNOW MESA DR STE 140
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80528-8614
Mailing Address - Country:US
Mailing Address - Phone:970-482-0213
Mailing Address - Fax:970-482-9646
Practice Address - Street 1:313 W DRAKE RD
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80526-2846
Practice Address - Country:US
Practice Address - Phone:970-482-8881
Practice Address - Fax:970-482-3253
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENDER MEDICAL GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-31
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO45095207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty