Provider Demographics
NPI:1740289339
Name:BENCHMARK ATLANTIC HEALTHCARE, INC.
Entity type:Organization
Organization Name:BENCHMARK ATLANTIC HEALTHCARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBISON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-578-0304
Mailing Address - Street 1:5407 BULL VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:MCHENRY
Mailing Address - State:IL
Mailing Address - Zip Code:60050-7410
Mailing Address - Country:US
Mailing Address - Phone:815-578-0304
Mailing Address - Fax:815-578-0343
Practice Address - Street 1:5407 BULL VALLEY RD
Practice Address - Street 2:
Practice Address - City:MCHENRY
Practice Address - State:IL
Practice Address - Zip Code:60050-7410
Practice Address - Country:US
Practice Address - Phone:815-578-0304
Practice Address - Fax:815-578-0343
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-18
Last Update Date:2024-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL203-000551332BC3200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332BC3200XSuppliersDurable Medical Equipment & Medical SuppliesCustomized Equipment
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL05632100OtherBLUE CROSS BLUE SHIELD OF
IL4480660001Medicare NSC