Healthcare Provider Details

I. General information

NPI: 1568940708
Provider Name (Legal Business Name): BENJAMIN OHEIM AGCNS-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/31/2018
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 N INTERSTATE 35 STE 700
AUSTIN TX
78705-1852
US

IV. Provider business mailing address

7016 RAZORS EDGE DR
AUSTIN TX
78744-3332
US

V. Phone/Fax

Practice location:
  • Phone: 512-807-3150
  • Fax:
Mailing address:
  • Phone: 806-570-7848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number881724
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberAP138289
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: