Provider Demographics
NPI:1760415640
Name:BENINGA, PAUL D (CRNA)
Entity Type:Individual
Prefix:
First Name:PAUL
Middle Name:D
Last Name:BENINGA
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 5045
Mailing Address - Street 2:C.B.O. PROV ENROLLMT
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57117-5045
Mailing Address - Country:US
Mailing Address - Phone:605-322-2754
Mailing Address - Fax:605-322-2727
Practice Address - Street 1:1325 S CLIFF AVE
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57105-1007
Practice Address - Country:US
Practice Address - Phone:605-322-2754
Practice Address - Fax:605-322-2727
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2014-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDR023547367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD5750954Medicaid
SD5750955Medicaid
MN006965500Medicaid
MN013K7BEOtherMN BCBS PROV#
NE460224743-48Medicaid
SD0006253OtherSD BLUE CROSS IND #
SD0030016OtherSD BLUE CROSS GROUP#
IA0573493Medicaid
SD5750954Medicaid
SD430073496/CE0909 RRMedicare PIN
SD0006253OtherSD BLUE CROSS IND #
SDS40287Medicare PIN