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NPI Code Detail

MEDICARE: DR. JON MICHAEL BENNETT DO

MEDICARE: DR. JON MICHAEL BENNETT DO
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
1207L00000XAnesthesiology Physician37755SC

Other Identifiers

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

General Provider Information

NPI Number : 1366427841
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JON MICHAEL BENNETT DO
Provider Business Mailing Address
First Line : 7900 N KINGS HWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29572-3055
Country : US
Telephone Number : 843-449-3381
Fax Number : 843-449-9721
Provider Business Practice Location Address
First Line : 7900 N KINGS HWY
Second Line :
City : MYRTLE BEACH
State : SC
Zip : 29572-3055
Country : US
Telephone Number : 843-449-3381
Fax Number : 843-449-9721
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/07/2005
Last Update Date : 10/10/2023

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