Organization
MID ATLANTIC HEALTH SPECIALISTS PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT BENISH (PRESIDENT)
(276) 236-2947
Entity
Organization
Contact information
Practice address
103 DOCTORS PARK, GALAX, VA 24333-2277
(276) 236-2947
Mailing address
103 DOCTORS PARK, GALAX, VA 24333-2277
(276) 236-2947
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
0101057515
VA
207RG0100X
Gastroenterology Physician
Primary
0101041026
VA
363A00000X
Physician Assistant
0110001464
VA
363LF0000X
Family Nurse Practitioner
0024103947
VA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
226464
BCBS
VA
05
—
890249M
—
NC
Enumeration date
03/28/2006
Last updated
03/03/2008
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