Healthcare Provider Details

I. General information

NPI: 1548513781
Provider Name (Legal Business Name): BENCHMARK MEDICAL GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2012
Last Update Date: 05/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1180 MAIN ST UNIT 8
WINDSOR CO
80550-4709
US

IV. Provider business mailing address

1180 MAIN ST UNIT 8
WINDSOR CO
80550-4709
US

V. Phone/Fax

Practice location:
  • Phone: 970-686-9117
  • Fax: 970-686-5441
Mailing address:
  • Phone: 970-686-9117
  • Fax: 970-686-5441

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number
License Number StateCO
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberDR0027625
License Number StateCO
# 4
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberDR0049628
License Number StateCO
# 5
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number StateCO
# 6
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCO
# 7
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number StateCO

VIII. Authorized Official

Name: MARI A RILEY
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 970-686-9117