Provider Demographics
NPI:1174586275
Name:BENDT, NISHUA F (DO)
Entity type:Individual
Prefix:
First Name:NISHUA
Middle Name:F
Last Name:BENDT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3231 S NATIONAL AVE STE 460
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65807-7304
Mailing Address - Country:US
Mailing Address - Phone:417-730-3030
Mailing Address - Fax:417-875-4715
Practice Address - Street 1:3231 S NATIONAL AVE STE 460
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65807-7304
Practice Address - Country:US
Practice Address - Phone:417-730-3030
Practice Address - Fax:417-875-4715
Is Sole Proprietor?:No
Enumeration Date:2006-04-10
Last Update Date:2018-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO119859207P00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO244685129Medicaid
MO1174586275Medicaid
P00360421OtherRR MEDICARE
G38294Medicare UPIN
MO1174586275Medicaid
MOMA1327020Medicare PIN