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
Update your record
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