| Brent Bennett Md | |
|
2300 Lohmans Spur #106 Lakeway TX 78734-6206 | |
| (512) 263-7133 | |
| (512) 263-0451 |
| Full Name | Brent Bennett Md |
|---|---|
| Speciality | Internal Medicine |
| Location | 2300 Lohmans Spur, Lakeway, Texas |
| Authorized Official Name and Position | Brent L. Bennett (OWNER/PRESIDENT) |
| Authorized Official Contact | 5122637133 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Brent Bennett Md 2300 Lohmans Spur #106 Lakeway TX 78734-6206 Ph: (512) 263-7133 | Brent Bennett Md 2300 Lohmans Spur #106 Lakeway TX 78734-6206 Ph: (512) 263-7133 |
| NPI Number | 1790753192 |
|---|---|
| Provider Enumeration Date | 03/10/2006 |
| Last Update Date | 04/08/2014 |
| Medicare PECOS PAC ID | 4385628924 |
|---|---|
| Medicare Enrollment ID | O20040802000812 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790753192 | NPI | - | NPPES |
| DN3479 | Other | TX | RAILROAD MEDICARE GROUP # |
| 0049KZ | Other | TX | BCBS OF TEXAS GROUP # |
| 167436801 | Medicaid | TX |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | G3150 (Texas) | Primary |
| Provider Name | Brent Bennett |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1871561035 PECOS PAC ID: 0840274403 Enrollment ID: I20040615000293 |
| Provider Name | Carol E Baker |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1144267808 PECOS PAC ID: 1355342536 Enrollment ID: I20070131000337 |
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