MEDICARE: BEND NATIONAL VETERAN & DOT EXAM CENTER, LLC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1790639342
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BEND NATIONAL VETERAN & DOT EXAM CENTER, LLC

Provider Business Mailing Address
First Line	:	735 DUGAN RIDGE DR # A
Second Line	:
City	:	BLACKLICK
State	:	OH
Zip	:	43004-7124
Country	:	US
Telephone Number	:	614-657-5157
Fax Number	:

Provider Business Practice Location Address
First Line	:	3184 W BROAD ST STE D
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43204-1327
Country	:	US
Telephone Number	:	614-657-5157
Fax Number	:

Authorized Official
Title or Position	:	CNP
Name	:	VICTORINE ANKONGBE NDEMATEBEM
Credential	:
Telephone Number	:	614-657-5157

Provider Enumeration Date	:	02/23/2026
Last Update Date	:	02/23/2026

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