| Benita Medical Llc | |
|
3465 Pioneer Pkwy Ste 2 West Valley City UT 84120-2076 | |
| (801) 963-7636 | |
| (801) 963-8130 |
| Full Name | Benita Medical Llc |
|---|---|
| Speciality | Family Medicine |
| Location | 3465 Pioneer Pkwy, West Valley City, Utah |
| Authorized Official Name and Position | Ray Morris (OWNER) |
| Authorized Official Contact | 8019737636 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Benita Medical Llc 3465 S 4155 W Ste 2 West Valley City UT 84120 Ph: (801) 963-7636 | Benita Medical Llc 3465 Pioneer Pkwy Ste 2 West Valley City UT 84120-2076 Ph: (801) 963-7636 |
| NPI Number | 1326263773 |
|---|---|
| Provider Enumeration Date | 04/13/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 0345270187 |
|---|---|
| Medicare Enrollment ID | O20050822000262 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1326263773 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 932651751205 (Utah) | Primary |
| Provider Name | Ray Morris |
|---|---|
| Provider Type | Practitioner - Family Practice |
| Provider Identifiers | NPI Number: 1023171014 PECOS PAC ID: 5799715538 Enrollment ID: I20070614000479 |
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