Provider Demographics
NPI:1023050549
Name:HUNEYCUTT, BENJAMIN STEWART (MD)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:STEWART
Last Name:HUNEYCUTT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PEACEHEALTH HOSPITAL MEDICINE
Mailing Address - Street 2:3377 RIVERBEND DRIVE
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-8803
Mailing Address - Country:US
Mailing Address - Phone:541-222-6389
Mailing Address - Fax:541-222-6385
Practice Address - Street 1:PEACEHEALTH HOSPITAL MEDICINE
Practice Address - Street 2:3377 RIVERBEND DRIVE
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-8803
Practice Address - Country:US
Practice Address - Phone:541-222-6389
Practice Address - Fax:541-222-6385
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-11
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD210106207Q00000X, 208M00000X
KY37413208M00000X, 207Q00000X
NMMD2013-0305208M00000X
AK218703208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64069305Medicaid
OH0111228Medicaid
KYP00479644OtherMEDICARE RAILROAD
OR500812735Medicaid
KY64069305Medicaid
OH0111228Medicaid
KY0741096Medicare PIN