MEDICARE: BENCOR MEDICAL LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285611012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENCOR MEDICAL LLC

Provider Business Mailing Address
First Line	:	4210 COLUMBIA RD
Second Line	:	BLDG 6
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0401
Country	:	US
Telephone Number	:	800-620-6327
Fax Number	:	706-869-7229

Provider Business Practice Location Address
First Line	:	4210 COLUMBIA RD
Second Line	:	BLDG 6
City	:	MARTINEZ
State	:	GA
Zip	:	30907-0401
Country	:	US
Telephone Number	:	800-620-6327
Fax Number	:	706-869-7229

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MR. JOHN R HUSS
Credential	:
Telephone Number	:	770-601-9199

Provider Enumeration Date	:	12/22/2005
Last Update Date	:	05/21/2010

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