Organization
POCATELLO CLINIC OF INTERNAL MEDICINE PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK P BENSON MD (OWNER)
(208) 233-4562
Entity
Organization
Contact information
Practice address
707 N 7TH, POCATELLO, ID 83201
(208) 233-4562
(208) 234-4638
Mailing address
PO BOX 880, POCATELLO, ID 83204
(208) 233-4562
(208) 234-4638
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
29296
GROUP BLUE SHIELD
ID
01
—
88765
GROUP BLUE CROSS
ID
01
—
CP9190
GROUP RAILROAD MEDICARE
ID
Enumeration date
03/27/2007
Last updated
08/22/2020
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