MEDICARE: BENJAMIN K MCINNES MD

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	208800000X	Urology Physician	8100	SC

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	1942242714	OTHER	SC	GROUP NPI

General Provider Information

NPI Number	:	1346200763
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BENJAMIN K MCINNES MD

Provider Business Mailing Address
First Line	:	2687 LAKE PARK DR
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9100
Country	:	US
Telephone Number	:	843-572-0097
Fax Number	:

Provider Business Practice Location Address
First Line	:	2687 LAKE PARK DR
Second Line	:
City	:	N CHARLESTON
State	:	SC
Zip	:	29406-9100
Country	:	US
Telephone Number	:	843-572-0097
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/28/2006
Last Update Date	:	05/23/2012

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