Provider Demographics
NPI:1851435986
Name:BRAINERD MEDICAL CENTER SC
Entity Type:Organization
Organization Name:BRAINERD MEDICAL CENTER SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:RAFER
Authorized Official - Last Name:BENIG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:773-445-8155
Mailing Address - Street 1:1222 W 95TH ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60643-1408
Mailing Address - Country:US
Mailing Address - Phone:773-445-8155
Mailing Address - Fax:773-779-7186
Practice Address - Street 1:1222 W 95TH ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60643-1408
Practice Address - Country:US
Practice Address - Phone:773-445-8155
Practice Address - Fax:773-779-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL207Q00000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Not Answered207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001635931OtherBCBS GROUP #
ILN276702OtherCORAZON BENIG'S HARMONY#
ILP00299437OtherCORAZON BENIG'S RRM PIN
ILP00288775OtherVINCENT BENIG-RRM PIN
ILDE3749OtherRAILROAD MEDICARE GRP#
ILH64112Medicare UPIN
IL213149Medicare ID - Type UnspecifiedMEDICARE GROUP #
ILK25741Medicare PIN
ILDE3749OtherRAILROAD MEDICARE GRP#
ILK25742Medicare PIN