Provider Demographics
NPI:1679746598
Name:BENNETT AND ASSOCIATES
Entity type:Organization
Organization Name:BENNETT AND ASSOCIATES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/TECHNICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:B
Authorized Official - Last Name:BENNETT
Authorized Official - Suffix:III
Authorized Official - Credentials:PHD,RVT
Authorized Official - Phone:740-502-6487
Mailing Address - Street 1:11500 RUBY RD
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:OH
Mailing Address - Zip Code:43725-9579
Mailing Address - Country:US
Mailing Address - Phone:740-502-6487
Mailing Address - Fax:740-439-8471
Practice Address - Street 1:11500 RUBY RD
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:OH
Practice Address - Zip Code:43725-9579
Practice Address - Country:US
Practice Address - Phone:740-502-6487
Practice Address - Fax:740-439-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-11
Last Update Date:2008-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0925333Medicaid
OHID00241Medicare PIN
OHX38576Medicare UPIN