MEDICARE: BENTON MEDICAL EQUIPMENT, INC.

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	332BC3200X	Customized Equipment (DME)	HMDRL 44407	CA
2	332BX2000X	Oxygen Equipment & Supplies (DME)	HMDRL 44407	CA
3	335E00000X	Prosthetic/Orthotic Supplier	HMDRL 44407	CA
4	332B00000X	Durable Medical Equipment & Medical Supplies	HMDRL 44407	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	ZZZ428502	OTHER	CA	BLUESHIELD
2	VENXXXN050892	OTHER	CA	AETNA

General Provider Information

NPI Number	:	1669680856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENTON MEDICAL EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	1145 TERRA BELLA AVE
Second Line	:	SUITE B
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1831
Country	:	US
Telephone Number	:	650-625-1000
Fax Number	:	650-625-1133

Provider Business Practice Location Address
First Line	:	2601 GARCIA AVE
Second Line	:
City	:	MOUNTAIN VIEW
State	:	CA
Zip	:	94043-1111
Country	:	US
Telephone Number	:	650-625-1000
Fax Number	:	650-625-1133

Authorized Official
Title or Position	:	PRESIDENT,CEO
Name	:	MR. JERRY BENTON JR.
Credential	:
Telephone Number	:	650-625-1000

Provider Enumeration Date	:	05/19/2007
Last Update Date	:	06/04/2012

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