Provider Demographics
NPI:1871815308
Name:GREGORY N BENTZEL DPM, LLC
Entity Type:Organization
Organization Name:GREGORY N BENTZEL DPM, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:N
Authorized Official - Last Name:BENTZEL
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:864-879-3888
Mailing Address - Street 1:PO BOX 1958
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29652-1958
Mailing Address - Country:US
Mailing Address - Phone:864-879-3888
Mailing Address - Fax:864-801-3272
Practice Address - Street 1:105 MIMOSA DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1737
Practice Address - Country:US
Practice Address - Phone:864-879-3888
Practice Address - Fax:864-801-3272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-02-25
Last Update Date:2015-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC70213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCT23677Medicare UPIN