Provider Demographics
NPI:1952743510
Name:BENDER MEDICAL GROUP
Entity Type:Organization
Organization Name:BENDER MEDICAL GROUP
Other - Org Name:MIRAMONT FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESAIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:970-225-5107
Mailing Address - Street 1:525 HATHAWAY
Mailing Address - Street 2:
Mailing Address - City:FAIRPLAY
Mailing Address - State:CO
Mailing Address - Zip Code:80440-0760
Mailing Address - Country:US
Mailing Address - Phone:719-836-1900
Mailing Address - Fax:719-836-3283
Practice Address - Street 1:525 HATHAWAY ST
Practice Address - Street 2:
Practice Address - City:FAIRPLAY
Practice Address - State:CO
Practice Address - Zip Code:80440-0760
Practice Address - Country:US
Practice Address - Phone:719-836-1900
Practice Address - Fax:719-836-3283
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-07-24
Last Update Date:2013-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty