=====================================================
General NPI Number Information
=====================================================
NPI Number | 1144632324
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENE SIT MANAGEMENT LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/22/2014
-----------------------------------------------------
Last Update Date | 05/22/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | #73 CALLE ALBIZUS CAMPOS
-----------------------------------------------------
City | TOA BAJA
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00959
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-740-3456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 56176
-----------------------------------------------------
City | BAYAMON
-----------------------------------------------------
State | PR
-----------------------------------------------------
Zip | 00960-6476
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 787-608-8568
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. HECTOR J RAMOS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 787-608-8568
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 302F00000X
-----------------------------------------------------
Taxonomy Name | Exclusive Provider Organization
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------