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Benjamin Keith Frederick

Radiology

Allopathic & Osteopathic Physicians

1 Hospital Dr, Dc069.10, Columbia, MO 65212-1000

PECOS Enrollment

This provider is enrolled in PECOS as BENJAMIN FREDERICK.

Based on the most recent information from CMS, provider Benjamin Keith Frederick is legally eligible to order and refer claims for Part B, HHA, DME and PMD services.

Part B
Medicare Part B
Enrolled
HHA
Home Health Agency
Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 2 days ago.

Profile Details

Provider ID
1982953378
Provider Type
Individual
Full Name
Frederick, Benjamin Keith
Title
Dr.
Credential
M.D.

Gender
Male
Sole Proprietor
Yes
Enumeration Date
8/31/2012
Last Updated
8/31/2012

Contact Information

Practice Location

1 Hospital Dr, Dc069.10, Columbia, MO 65212-1000

(573) 882-7901

Unlisted Fax

Mailing Location

1 Hospital Dr, Dc069.10, Columbia, MO 65212-1000

Unlisted Phone

Unlisted Fax

Provider Taxonomies

Code	Description	License
Code 2085R0202X Primary	Description Radiology Allopathic & Osteopathic Physicians	License 2012026888 Missouri

Benjamin Keith Frederick

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Connors, James Phillip

Kunin, Jeffrey R

Cleek, John

Lage, Kraig Jason

Aro, Michael Rantiolu

Garg, Megha

Crim, Julia Ruth

Tahon, Nourel Hoda

Hillard, Alan E

Morrell, Joshua