Provider Demographics
NPI:1801173307
Name:BENSON CHARLES DREW HEALTH CENTER
Entity type:Organization
Organization Name:BENSON CHARLES DREW HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:
Authorized Official - Last Name:BARR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-457-1200
Mailing Address - Street 1:5420 NW RADIAL HWY
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68104-3592
Mailing Address - Country:US
Mailing Address - Phone:402-558-9242
Mailing Address - Fax:402-558-1210
Practice Address - Street 1:5420 NW RADIAL HWY
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68104-3592
Practice Address - Country:US
Practice Address - Phone:402-558-9242
Practice Address - Fax:402-558-1210
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHARLES DREW HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-11-11
Last Update Date:2011-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)