MEDICARE: BENDER MEDICAL GROUP INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	42203	CO
2	207Q00000X	Family Medicine Physician	45095	CO
3	207Q00000X	Family Medicine Physician	27536	CO
4	207Q00000X	Family Medicine Physician	40384	CO
5	207Q00000X	Family Medicine Physician	21180	CO
6	207Q00000X	Family Medicine Physician	31325	CO
7	207Q00000X	Family Medicine Physician	46447	CO
8	363A00000X	Physician Assistant	1082	CO
9	363A00000X	Physician Assistant	905	CO
10	363A00000X	Physician Assistant	2790	CO
11	363A00000X	Physician Assistant	2589	CO
12	363L00000X	Nurse Practitioner	NP10339	CO
13	207Q00000X	Family Medicine Physician	32679	CO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	654282	OTHER		BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1215027107
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENDER MEDICAL GROUP INC

Provider Business Mailing Address
First Line	:	4674 SNOW MESA DR
Second Line	:	STE 140
City	:	FT COLLINS
State	:	CO
Zip	:	80528
Country	:	US
Telephone Number	:	970-482-0213
Fax Number	:	970-482-9646

Provider Business Practice Location Address
First Line	:	4674 SNOW MESA DR
Second Line	:	STE 140
City	:	FT COLLINS
State	:	CO
Zip	:	80528
Country	:	US
Telephone Number	:	970-482-0213
Fax Number	:	970-482-9646

Authorized Official
Title or Position	:	PRACTICE ADMIN
Name	:	MRS. TERESA E BENDER
Credential	:
Telephone Number	:	970-482-0213

Provider Enumeration Date	:	10/13/2006
Last Update Date	:	03/05/2013

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1619042256 — JESSICA TRAVIS FNP
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1164580346 — ALLISON MADDOX SCHINDLER PA-C
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Directions to “BENDER MEDICAL GROUP INC ” Practice Location

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