Healthcare Provider Details

I. General information

NPI: 1881813475
Provider Name (Legal Business Name): BENKE EAR NOSE AND THROAT CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 04/14/2022
Certification Date: 04/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1317 GLENWOOD DR
CLEBURNE TX
76033
US

IV. Provider business mailing address

1317 GLENWOOD DR
CLEBURNE TX
76033
US

V. Phone/Fax

Practice location:
  • Phone: 817-641-3750
  • Fax:
Mailing address:
  • Phone: 817-641-3750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License NumberH7889
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License NumberH7889
License Number StateTX

VIII. Authorized Official

Name: DR. THEODORE T BENKE
Title or Position: OWNER PRESIDENT
Credential: M.D.
Phone: 817-641-3750