=====================================================
General NPI Number Information
=====================================================
NPI Number | 1245423821
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DEWEY F BENSENHAVER
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/27/2007
-----------------------------------------------------
Last Update Date | 01/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | HC 30 BOX 95
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26847-9410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-257-1456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | HC 30 BOX 95
-----------------------------------------------------
City | PETERSBURG
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26847-9410
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-257-1456
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | DEWEY F BENSENHAVER
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 304-257-1456
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QP2300X
-----------------------------------------------------
Taxonomy Name | Primary Care Clinic/Center
-----------------------------------------------------
License Number | WV09657
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------