Provider Demographics
NPI:1932101292
Name:BENESCH, MARK E (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:BENESCH
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1454 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:NE
Mailing Address - Zip Code:68601-4944
Mailing Address - Country:US
Mailing Address - Phone:402-564-2816
Mailing Address - Fax:402-564-1312
Practice Address - Street 1:1454 28TH AVE
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:NE
Practice Address - Zip Code:68601-4944
Practice Address - Country:US
Practice Address - Phone:402-564-2816
Practice Address - Fax:402-564-1312
Is Sole Proprietor?:No
Enumeration Date:2005-06-01
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE52300363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE240471OtherCOVENTRY FOR CCH
NE4319OtherMIDLANDS CHOICE FOR CCH
NE38702OtherBCBS NE FOR CCH
NE47055169400Medicaid
NE38702OtherBCBS NE FOR CCH
NE264547BEMedicare ID - Type Unspecified
NE279123Medicare ID - Type UnspecifiedMEDICARE FOR CCH