MEDICARE: BENCHMARK ATLANTIC HEALTHCARE, 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)	203-000551	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	05632100	OTHER	IL	BLUE CROSS BLUE SHIELD OF

General Provider Information

NPI Number	:	1740289339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BENCHMARK ATLANTIC HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	5407 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-578-0304
Fax Number	:	815-578-0343

Provider Business Practice Location Address
First Line	:	5407 BULL VALLEY RD
Second Line	:
City	:	MCHENRY
State	:	IL
Zip	:	60050-7410
Country	:	US
Telephone Number	:	815-578-0304
Fax Number	:	815-578-0343

Authorized Official
Title or Position	:	CO OWNER
Name	:	KIMBERLY ROBISON
Credential	:
Telephone Number	:	815-578-0304

Provider Enumeration Date	:	07/18/2005
Last Update Date	:	05/24/2024

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