Provider Demographics
NPI:1215166806
Name:WILLIAM J VANBENEDEN DO PLLC
Entity type:Organization
Organization Name:WILLIAM J VANBENEDEN DO PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:VANBENEDEN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:606-325-8561
Mailing Address - Street 1:2550 CARTER AVE
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41101-7830
Mailing Address - Country:US
Mailing Address - Phone:606-325-8561
Mailing Address - Fax:606-325-3591
Practice Address - Street 1:2550 CARTER AVE
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:KY
Practice Address - Zip Code:41101-7830
Practice Address - Country:US
Practice Address - Phone:606-325-8561
Practice Address - Fax:606-325-3591
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY03158207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY01040001Medicare PIN