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General NPI Number Information
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NPI Number | 1053837104
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Entity Type | Organization
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Legal Business Name | BENNETT MEDICAL CLINIC, LLC
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Dates
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Enumeration Date | 08/21/2017
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Last Update Date | 08/21/2017
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Provider Practice Location Address
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Address Line | 10876A N JACOB SMART BLVD
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City | RIDGELAND
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State | SC
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Zip | 29936-2707
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Country | US
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Telephone | 843-694-7728
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Fax |
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Provider Business Mailing Address
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Address Line | 71 PINE RIDGE DR
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City | BLUFFTON
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State | SC
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Zip | 29910-7847
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | CATHERINE BENNETT
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Credential | APRN
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Telephone | 843-694-7728
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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