| Benjamin Outreach Medical Network Corporation | |
|
3939 Hollywood Blvd Ste 1b Hollywood FL 33021-6749 | |
| (954) 251-0267 | |
| (754) 212-0473 |
| Full Name | Benjamin Outreach Medical Network Corporation |
|---|---|
| Speciality | Clinic/Center |
| Location | 3939 Hollywood Blvd Ste 1b, Hollywood, Florida |
| Authorized Official Name and Position | Ilnise Mathieu (OFFICE MANAGER) |
| Authorized Official Contact | 9542510267 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benjamin Outreach Medical Network Corporation 3939 Hollywood Blvd Ste 1b Hollywood FL 33021-6749 Ph: (954) 251-0267 | Benjamin Outreach Medical Network Corporation 3939 Hollywood Blvd Ste 1b Hollywood FL 33021-6749 Ph: (954) 251-0267 |
| NPI Number | 1518248418 |
|---|---|
| Provider Enumeration Date | 09/06/2011 |
| Last Update Date | 07/04/2025 |
| Certification Date | 07/04/2025 |
| Medicare PECOS PAC ID | 9537331772 |
|---|---|
| Medicare Enrollment ID | O20111011000541 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518248418 | NPI | - | NPPES |
| 279510800 | Medicaid | FL |
| Provider Name | Vaunrance Benjamin |
|---|---|
| Provider Type | Practitioner - Obstetrics/gynecology |
| Provider Identifiers | NPI Number: 1831178706 PECOS PAC ID: 2860429289 Enrollment ID: I20071126000246 |
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