Healthcare Provider Details

I. General information

NPI: 1053837104
Provider Name (Legal Business Name): BENNETT MEDICAL CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/21/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10876A N JACOB SMART BLVD
RIDGELAND SC
29936-2707
US

IV. Provider business mailing address

71 PINE RIDGE DR
BLUFFTON SC
29910-7847
US

V. Phone/Fax

Practice location:
  • Phone: 843-694-7728
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CATHERINE BENNETT
Title or Position: OWNER
Credential: APRN
Phone: 843-694-7728