Healthcare Provider Details

I. General information

NPI: 1225141211
Provider Name (Legal Business Name): MICHELLE L BENES M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 10/31/2022
Certification Date: 10/31/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1035 W MAIN ST
CENTRAL SC
29630-9229
US

IV. Provider business mailing address

PO BOX 100174
COLUMBIA SC
29202-3174
US

V. Phone/Fax

Practice location:
  • Phone: 864-512-7740
  • Fax: 864-512-7741
Mailing address:
  • Phone: 864-512-3076
  • Fax: 864-512-2379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number21721
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number86172
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: