MEDICARE: ROSS B BENGTSON

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	208600000X	Surgery Physician	45928	MN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	45928	OTHER	MN	LICENSE NUMBER
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1417931593
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSS B BENGTSON

Provider Business Mailing Address
First Line	:	523 N 3RD ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-3054
Country	:	US
Telephone Number	:	218-829-2861
Fax Number	:

Provider Business Practice Location Address
First Line	:	2024 S 6TH ST
Second Line	:
City	:	BRAINERD
State	:	MN
Zip	:	56401-4529
Country	:	US
Telephone Number	:	218-828-7100
Fax Number	:

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

Provider Enumeration Date	:	12/02/2005
Last Update Date	:	01/07/2016

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Directions to “ ROSS B BENGTSON ” Practice Location

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