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Brent Benso

Physician Assistant

Physician Assistants & Advanced Practice Nursing Providers

25 Michigan St NE, Suite 6100, Grand Rapids, MI 49503-2515

PECOS Enrollment

Based on the most recent information from CMS, provider Brent Benso is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records today at 10:37 AM.

Profile Details

Provider ID
1376965582
Provider Type
Individual
Full Name
Benso, Brent
Gender
Male

Sole Proprietor
No
Enumeration Date
1/8/2014
Last Updated
1/8/2014

Contact Information

Practice Location

25 Michigan St NE, Suite 6100, Grand Rapids, MI 49503-2515

(616) 267-7900

Unlisted Fax

Mailing Location

100 Michign St NE, Mc 845, Grand Rapids, MI 49503-2560

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 363A00000X Primary	Description Physician Assistant Physician Assistants & Advanced Practice Nursing Providers	License 5601006815 Michigan

Brent Benso

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Pebbles, Timothy Allen

Maatman, Caleb R

Rogers, Abby Jayne

Lee, Avery Perrin

Schoen, Kailey

Meyer, Kylie

Calkins, Laura Elizabeth

O'Rourke, Lois Anne

Cook, Brittany Ann

Vandeusen, Julie