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General NPI Number Information
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NPI Number | 1093956526
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Entity Type | Organization
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Legal Business Name | BENTON PEDIATRICS
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Dates
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Enumeration Date | 03/12/2009
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Last Update Date | 10/17/2024
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Provider Practice Location Address
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Address Line | 5612 NW 43RD ST
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City | GAINESVILLE
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State | FL
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Zip | 32653-3332
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Country | US
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Telephone | 352-376-4542
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Fax | 352-376-4959
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Provider Business Mailing Address
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Address Line | 5612 NW 43RD ST
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City | GAINESVILLE
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State | FL
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Zip | 32653-3332
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Country | US
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Telephone | 352-376-4542
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Fax | 352-376-4959
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. CHARLES KENT POWERS III
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Credential | MD
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Telephone | 352-376-4542
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 282NC2000X
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Taxonomy Name | Children's Hospital
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License Number | ME53353
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 320800000X
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Taxonomy Name | Mental Illness Community Based Residential Treatment Facility
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License Number |
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License Number State |
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