Provider Demographics
NPI:1548513781
Name:BENCHMARK MEDICAL GROUP INC
Entity type:Organization
Organization Name:BENCHMARK MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MARI
Authorized Official - Middle Name:A
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:970-686-9117
Mailing Address - Street 1:1180 MAIN ST
Mailing Address - Street 2:UNIT 8
Mailing Address - City:WINDSOR
Mailing Address - State:CO
Mailing Address - Zip Code:80550-4709
Mailing Address - Country:US
Mailing Address - Phone:970-686-9117
Mailing Address - Fax:970-686-5441
Practice Address - Street 1:1180 MAIN ST
Practice Address - Street 2:UNIT 8
Practice Address - City:WINDSOR
Practice Address - State:CO
Practice Address - Zip Code:80550-4709
Practice Address - Country:US
Practice Address - Phone:970-686-9117
Practice Address - Fax:970-686-5441
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-25
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO332B00000X, 225100000X, 111NR0400X, 111N00000X, 363LF0000X
CODR0027625207L00000X
CODR0049628207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No111NR0400XChiropractic ProvidersChiropractorRehabilitationGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO263094YL80Medicare PIN
CO6714170001Medicare NSC