Provider Demographics
NPI:1003914888
Name:BENJAMIN A. WENDELL, MD LLC
Entity type:Organization
Organization Name:BENJAMIN A. WENDELL, MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:A
Authorized Official - Last Name:WENDELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-232-3664
Mailing Address - Street 1:2901 OHIO BLVD
Mailing Address - Street 2:SUITE 127
Mailing Address - City:TERRE HAUTE
Mailing Address - State:IN
Mailing Address - Zip Code:47803-2239
Mailing Address - Country:US
Mailing Address - Phone:812-234-8261
Mailing Address - Fax:812-234-8262
Practice Address - Street 1:RR 1 BOX 1000
Practice Address - Street 2:
Practice Address - City:LINTON
Practice Address - State:IN
Practice Address - Zip Code:47441-9482
Practice Address - Country:US
Practice Address - Phone:812-847-2281
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01037092A2085R0202X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100124880Medicaid
IN239260Medicare PIN
IN100124880Medicaid