Provider Demographics
NPI:1780310482
Name:RENEWED HEALTH SOLUTIONS LLC
Entity type:Organization
Organization Name:RENEWED HEALTH SOLUTIONS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:BENEDICT
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:417-576-1726
Mailing Address - Street 1:10239 COUNTY ROAD 319
Mailing Address - Street 2:
Mailing Address - City:CROSS TIMBERS
Mailing Address - State:MO
Mailing Address - Zip Code:65634-8430
Mailing Address - Country:US
Mailing Address - Phone:417-576-1726
Mailing Address - Fax:
Practice Address - Street 1:10239 COUNTY ROAD 319
Practice Address - Street 2:
Practice Address - City:CROSS TIMBERS
Practice Address - State:MO
Practice Address - Zip Code:65634-8430
Practice Address - Country:US
Practice Address - Phone:417-576-1726
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-26
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Single Specialty