Provider Demographics
NPI:1588346357
Name:TEAM BENTSON ENTERPRISE PLLC
Entity type:Organization
Organization Name:TEAM BENTSON ENTERPRISE PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:BENTSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:507-317-1567
Mailing Address - Street 1:303 E 1ST ST
Mailing Address - Street 2:
Mailing Address - City:JANESVILLE
Mailing Address - State:MN
Mailing Address - Zip Code:56048-3044
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:303 E 1ST ST
Practice Address - Street 2:
Practice Address - City:JANESVILLE
Practice Address - State:MN
Practice Address - Zip Code:56048-3044
Practice Address - Country:US
Practice Address - Phone:507-317-1567
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-02
Last Update Date:2023-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center