Healthcare Provider Details

I. General information

NPI: 1356711378
Provider Name (Legal Business Name): BENDERS MEDICAL SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/02/2015
Last Update Date: 01/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2415 SOUTH AVE
LEESBURG FL
34748-8180
US

IV. Provider business mailing address

2415 SOUTH AVE
LEESBURG FL
34748-8180
US

V. Phone/Fax

Practice location:
  • Phone: 352-404-3566
  • Fax: 352-323-1924
Mailing address:
  • Phone: 352-404-3566
  • Fax: 352-323-1924

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number StateFL

VIII. Authorized Official

Name: MRS. TAMARA BENDER
Title or Position: 0WNER
Credential:
Phone: 352-404-3566