Provider Demographics
NPI:1508006263
Name:BENSON PODIATRY ASSOC PC
Entity type:Organization
Organization Name:BENSON PODIATRY ASSOC PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:PATRICK
Authorized Official - Last Name:YORK
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:402-212-6001
Mailing Address - Street 1:4652 MASON ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2020
Mailing Address - Country:US
Mailing Address - Phone:402-212-6001
Mailing Address - Fax:402-556-6998
Practice Address - Street 1:6751 N 72ND STREET
Practice Address - Street 2:SUITE 201
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68122
Practice Address - Country:US
Practice Address - Phone:402-212-6001
Practice Address - Fax:402-572-3604
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENSON PODIATRY ASSOC PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-20
Last Update Date:2025-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE215332B00000X, 213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========00Medicaid
NE=========00Medicaid