Provider Demographics
NPI:1750560926
Name:BENJAMIN MEDICAL ASSOCIATES, PA
Entity type:Organization
Organization Name:BENJAMIN MEDICAL ASSOCIATES, PA
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JENSE
Authorized Official - Middle Name:
Authorized Official - Last Name:BENJAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:972-613-1000
Mailing Address - Street 1:1611 N BELT LINE RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:MESQUITE
Mailing Address - State:TX
Mailing Address - Zip Code:75149-1722
Mailing Address - Country:US
Mailing Address - Phone:972-613-1000
Mailing Address - Fax:972-613-4232
Practice Address - Street 1:1611 N BELT LINE RD
Practice Address - Street 2:SUITE A
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-1722
Practice Address - Country:US
Practice Address - Phone:972-613-1000
Practice Address - Fax:972-613-4232
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENJAMIN MEDICAL ASSOCIATES, PA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-10-24
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX166121701Medicaid
TX00510WMedicare PIN