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Organization

BENTON PEDIATRICS

Active
Organization subpart
No

Provider details

NPI number
Authorized official
DR. CHARLES KENT POWERS III MD (MD/OWNER)
(352) 376-4542
Entity
Organization

Contact information

Practice address
5612 NW 43RD ST, GAINESVILLE, FL 32653-3332
(352) 376-4542
(352) 376-4959
Mailing address
5612 NW 43RD ST, GAINESVILLE, FL 32653-3332
(352) 376-4542
(352) 376-4959

Taxonomy

Speciality
Code
Description
License number
State
282NC2000X
Children's Hospital
ME53353
FL
320800000X
Mental Illness Community Based Residential Treatment Facility
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
048463600
FL
Enumeration date
03/12/2009
Last updated
10/17/2024
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