Individual ProviderBenjamin HannahInternal MedicineAllopathic & Osteopathic PhysiciansPractice Address550 S Jackson St, Room A3k00, Louisville, KY 40202-1622(502) 852-4277PECOS EnrollmentBased on the most recent information from CMS, provider Benjamin Hannah is legally eligible to order and refer claims for DME and PMD services only.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentEnrolledPMDPower Mobility DeviceEnrolledCMS last updated its PECOS records 3 days ago.Profile DetailsProvider ID1760846869Provider TypeIndividualFull NameHannah, BenjaminCredentialMDGenderMaleSole ProprietorNoEnumeration Date4/5/2016Last Updated6/12/2020Contact InformationPractice LocationPractice Address550 S Jackson St, Room A3k00, Louisville, KY 40202-1622Phone(502) 852-4277Fax(502) 852-8980Mailing LocationMailing Address550 S Jackson St, Room A3k00, Louisville, KY 40202-1622Phone(502) 852-4277Fax(502) 852-8980Provider TaxonomiesCodeDescriptionLicenseCode207R00000XPrimaryDescriptionInternal MedicineAllopathic & Osteopathic PhysiciansLicense53826KentuckyCode390200000XDescriptionStudent in an Organized Health Care Education/Training ProgramStudent, Health CareLicenseUnlisted Issuer