Provider Demographics
NPI:1972553162
Name:BENJAMINO LOUIS GRANATO
Entity type:Organization
Organization Name:BENJAMINO LOUIS GRANATO
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BENJAMINO
Authorized Official - Middle Name:L
Authorized Official - Last Name:GRANATO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-521-5884
Mailing Address - Street 1:PO BOX 761801
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78245-6801
Mailing Address - Country:US
Mailing Address - Phone:210-521-5884
Mailing Address - Fax:210-521-0074
Practice Address - Street 1:6415 BANDERA RD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78238-1512
Practice Address - Country:US
Practice Address - Phone:210-521-5884
Practice Address - Fax:210-521-0074
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-11
Last Update Date:2009-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX0079071332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX141811301Medicaid
TX141811301Medicaid