Provider Demographics
NPI:1295595106
Name:BENNETT SUPPLY AND SERVICES LLC
Entity type:Organization
Organization Name:BENNETT SUPPLY AND SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAWNELE
Authorized Official - Middle Name:D
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:316-393-5256
Mailing Address - Street 1:245 N WACO ST STE 220
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67202-1102
Mailing Address - Country:US
Mailing Address - Phone:316-722-2138
Mailing Address - Fax:800-735-8893
Practice Address - Street 1:245 N WACO ST STE 220
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67202-1102
Practice Address - Country:US
Practice Address - Phone:316-722-2138
Practice Address - Fax:833-464-2530
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-19
Last Update Date:2025-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty