Provider Demographics
NPI:1184074593
Name:STUART J. BENSON, D.O., P.A.
Entity type:Organization
Organization Name:STUART J. BENSON, D.O., P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:STUART
Authorized Official - Middle Name:J
Authorized Official - Last Name:BENSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:479-531-9300
Mailing Address - Street 1:808 S 52ND ST
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ROGERS
Mailing Address - State:AR
Mailing Address - Zip Code:72758-8602
Mailing Address - Country:US
Mailing Address - Phone:479-319-6009
Mailing Address - Fax:479-319-6002
Practice Address - Street 1:808 S 52ND ST
Practice Address - Street 2:SUITE 201
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72758-8602
Practice Address - Country:US
Practice Address - Phone:479-319-6009
Practice Address - Fax:479-319-6002
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-06-16
Last Update Date:2016-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARN8003261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR118662003Medicaid
AR264001YJLLMedicare Oscar/Certification
ARE91741/54185Medicare UPIN