Provider Demographics
NPI:1497861819
Name:BENWOOD MEDICAL CLINIC INC
Entity type:Organization
Organization Name:BENWOOD MEDICAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LAWRENCE
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:KELLY
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:304-233-1656
Mailing Address - Street 1:4850 EOFF ST
Mailing Address - Street 2:
Mailing Address - City:BENWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26031-1008
Mailing Address - Country:US
Mailing Address - Phone:304-233-1656
Mailing Address - Fax:304-233-1667
Practice Address - Street 1:4850 EOFF ST
Practice Address - Street 2:
Practice Address - City:BENWOOD
Practice Address - State:WV
Practice Address - Zip Code:26031-1008
Practice Address - Country:US
Practice Address - Phone:304-233-1656
Practice Address - Fax:304-233-1667
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty