| Mark Bennett Pllc | |
|
2775 Channing Way Idaho Falls ID 83404-7510 | |
| (208) 524-0133 | |
| Not Available |
| Full Name | Mark Bennett Pllc |
|---|---|
| Speciality | Social Worker |
| Location | 2775 Channing Way, Idaho Falls, Idaho |
| Authorized Official Name and Position | Mark Barry Bennett (CLINICAL SOCIAL WORKER) |
| Authorized Official Contact | 2085219437 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Mark Bennett Pllc 320 Red Fox Dr Idaho Falls ID 83401-3479 Ph: (208) 521-9437 | Mark Bennett Pllc 2775 Channing Way Idaho Falls ID 83404-7510 Ph: (208) 524-0133 |
| NPI Number | 1285396481 |
|---|---|
| Provider Enumeration Date | 10/06/2021 |
| Last Update Date | 10/06/2021 |
| Certification Date | 10/04/2021 |
| Medicare PECOS PAC ID | 0941694871 |
|---|---|
| Medicare Enrollment ID | O20220218001156 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1285396481 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Mark Barry Bennett |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1306273784 PECOS PAC ID: 2860820727 Enrollment ID: I20200309000520 |
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