Organization
BENTON MEDICAL EQUIPMENT, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. JERRY BENTON JR. (PRESIDENT,CEO)
(650) 625-1000
Entity
Organization
Contact information
Practice address
2601 GARCIA AVE, MOUNTAIN VIEW, CA 94043-1111
(650) 625-1000
(650) 625-1133
Mailing address
1145 TERRA BELLA AVE, SUITE B, MOUNTAIN VIEW, CA 94043-1831
(650) 625-1000
(650) 625-1133
Taxonomy
Speciality
Code
Description
License number
State
332B00000X
Durable Medical Equipment & Medical Supplies
Primary
HMDRL 44407
CA
332BC3200X
Customized Equipment (DME)
HMDRL 44407
CA
332BX2000X
Oxygen Equipment & Supplies (DME)
HMDRL 44407
CA
335E00000X
Prosthetic/Orthotic Supplier
HMDRL 44407
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
VENXXXN050892
AETNA
CA
01
—
ZZZ428502
BLUESHIELD
CA
Enumeration date
05/19/2007
Last updated
06/04/2012
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