Provider Demographics
NPI:1285611012
Name:BENCOR MEDICAL LLC
Entity type:Organization
Organization Name:BENCOR MEDICAL LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:R
Authorized Official - Last Name:HUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:770-601-9199
Mailing Address - Street 1:4210 COLUMBIA RD
Mailing Address - Street 2:BLDG 6
Mailing Address - City:MARTINEZ
Mailing Address - State:GA
Mailing Address - Zip Code:30907-0401
Mailing Address - Country:US
Mailing Address - Phone:800-620-6327
Mailing Address - Fax:706-869-7229
Practice Address - Street 1:4210 COLUMBIA RD
Practice Address - Street 2:BLDG 6
Practice Address - City:MARTINEZ
Practice Address - State:GA
Practice Address - Zip Code:30907-0401
Practice Address - Country:US
Practice Address - Phone:800-620-6327
Practice Address - Fax:706-869-7229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-22
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA040918183AMedicaid
SCDE2533Medicaid
5345940002Medicare NSC