MEDICARE: DR. PAMELA S. BENBOW AU.D.

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	231H00000X	Audiologist	336	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

General Provider Information

NPI Number	:	1477746568
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. PAMELA S. BENBOW AU.D.

Provider Business Mailing Address
First Line	:	5913 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2329
Country	:	US
Telephone Number	:	843-497-6156
Fax Number	:	843-449-9946

Provider Business Practice Location Address
First Line	:	5913 N KINGS HWY
Second Line	:
City	:	MYRTLE BEACH
State	:	SC
Zip	:	29577-2329
Country	:	US
Telephone Number	:	843-497-6156
Fax Number	:	843-449-9946

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

Provider Enumeration Date	:	08/22/2007
Last Update Date	:	03/06/2012

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