Basic Information
| Provider Information | |||||||||
| NPI: | 1730184003 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BENOIT | ||||||||
| FirstName: | GENA | ||||||||
| MiddleName: | L.R. | ||||||||
| NamePrefix: | |||||||||
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| Credential: | MD | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | MEYER | ||||||||
| OtherFirstName: | GENA | ||||||||
| OtherMiddleName: | L.R. | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 865 LINCOLN RD | ||||||||
| Address2: | STE L10 | ||||||||
| City: | BETTENDORF | ||||||||
| State: | IA | ||||||||
| PostalCode: | 527224159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5633559191 | ||||||||
| FaxNumber: | 5633553419 | ||||||||
| Practice Location | |||||||||
| Address1: | 1345 W CENTRAL PARK AVE | ||||||||
| Address2: | |||||||||
| City: | DAVENPORT | ||||||||
| State: | IA | ||||||||
| PostalCode: | 528041844 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5634214400 | ||||||||
| FaxNumber: | 5634214449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/14/2005 | ||||||||
| LastUpdateDate: | 04/20/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
| AuthorizedOfficialLastName: | |||||||||
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| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 04/20/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | 33633 | IA | Y | Allopathic & Osteopathic Physicians | Family Medicine |
ID Information
| ID | Type | State | Issuer | Description | 4796890003 | 01 | DMERC | OTHER | IA01C8 | 01 | JOHN DEERE HEALTH PLAN | OTHER | 080185468 | 01 | RAILROAD MEDICARE | OTHER | 077432 | 01 | HEALTH ALLIANCE | OTHER | 3192799 | 05 | IA | MEDICAID | 143695 | 01 | IOWA HEALTH SOLUTIONS | OTHER | 55817 | 01 | IA | WELLMARK HEALTH PLANS | OTHER |