Provider Demographics
NPI:1194838235
Name:BENEFIS HEALTHCARE PRACTITIONERS, PC
Entity Type:Organization
Organization Name:BENEFIS HEALTHCARE PRACTITIONERS, PC
Other - Org Name:WOUND CARE AND HYPERBARIC MEDICINE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GUY
Authorized Official - Middle Name:T
Authorized Official - Last Name:HAYTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-455-4475
Mailing Address - Street 1:500 15TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-4324
Mailing Address - Country:US
Mailing Address - Phone:406-455-2680
Mailing Address - Fax:406-455-2685
Practice Address - Street 1:500 15TH AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4324
Practice Address - Country:US
Practice Address - Phone:406-455-2680
Practice Address - Fax:406-455-2685
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEFIS HEALTHCARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-08-15
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8144207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0151814Medicaid