Individual ProviderJerry D BenitoneSpecialistOther Service ProvidersPractice Address2144 Monroe Ave, Memphis, TN 38104-4229(901) 274-9046PECOS EnrollmentBased on the most recent information from CMS, provider Jerry D Benitone does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records yesterday at 12:57 PM.Profile DetailsProvider ID1629073119Provider TypeIndividualFull NameBenitone, Jerry DTitleDr.CredentialM.D.GenderMaleSole ProprietorNoEnumeration Date6/20/2005Last Updated7/9/2007Contact InformationPractice LocationPractice Address2144 Monroe Ave, Memphis, TN 38104-4229Phone(901) 274-9046Fax(901) 272-7360Mailing LocationMailing Address2144 Monroe Ave, Memphis, TN 38104-4229Phone(901) 274-9046Fax(901) 272-7360Provider TaxonomiesCodeDescriptionLicenseCode174400000XPrimaryDescriptionSpecialistOther Service ProvidersLicenseMD0000006809TennesseeProvider IdentifiersIDDescriptionIssuerID00010364DescriptionMedicaidIssuerUnlistedMississippiID3191624DescriptionMedicaidIssuerUnlistedTennessee