Provider Demographics
| NPI: | 1346489598 |
|---|---|
| Name: | BENEFIS MEDICAL GROUP |
| Entity Type: | Organization |
| Organization Name: | BENEFIS MEDICAL GROUP |
| Other - Org Name: | BENEFIS PHYSICIAN ASSOCIATES, INC. |
| Other - Org Type: | Former Legal Business Name |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | DR |
| Authorized Official - First Name: | JERRY |
| Authorized Official - Middle Name: | W |
| Authorized Official - Last Name: | SPEER |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | MD |
| Authorized Official - Phone: | 406-455-2920 |
| Mailing Address - Street 1: | P.O. BOX 6010 |
| Mailing Address - Street 2: | BENEFIS PHYSICIAN ASSOCIATES |
| Mailing Address - City: | GREAT FALLS |
| Mailing Address - State: | MT |
| Mailing Address - Zip Code: | 59406-6010 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 406-455-2900 |
| Mailing Address - Fax: | 406-455-2902 |
| Practice Address - Street 1: | 500 15TH AVENUE SOUTH |
| Practice Address - Street 2: | GROUND FLOOR |
| Practice Address - City: | GREAT FALLS |
| Practice Address - State: | MT |
| Practice Address - Zip Code: | 59405-4304 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 406-455-2900 |
| Practice Address - Fax: | 406-455-2902 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | Yes |
| Parent Organization LBN: | BENEFIS HEALTH SYSTEM |
| Parent Organization TIN: | <UNAVAIL> |
| Enumeration Date: | 2009-02-11 |
| Last Update Date: | 2010-11-22 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| MT | 8503 | 207Q00000X |
| MT | 11418 | 207RC0000X, 207RI0011X |
| MT | 10267 | 207RC0200X |
| MT | 11973 | 207RE0101X |
| MT | 10557 | 207RG0300X |
| MT | 4766 | 207RP1001X |
| MT | 11382 | 207VX0201X |
| MT | 11812 | 2080N0001X |
| MT | 11840 | 2085R0001X |
| MT | 11426 | 208600000X |
| MT | 10564 | 208800000X |
| MT | 9761 | 208G00000X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 207Q00000X | Allopathic & Osteopathic Physicians | Family Medicine | Group - Multi-Specialty | |
| No | 207RC0000X | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | Group - Multi-Specialty |
| No | 207RC0200X | Allopathic & Osteopathic Physicians | Internal Medicine | Critical Care Medicine | Group - Multi-Specialty |
| No | 207RE0101X | Allopathic & Osteopathic Physicians | Internal Medicine | Endocrinology, Diabetes & Metabolism | Group - Multi-Specialty |
| No | 207RG0300X | Allopathic & Osteopathic Physicians | Internal Medicine | Geriatric Medicine | Group - Multi-Specialty |
| No | 207RI0011X | Allopathic & Osteopathic Physicians | Internal Medicine | Interventional Cardiology | Group - Multi-Specialty |
| No | 207RP1001X | Allopathic & Osteopathic Physicians | Internal Medicine | Pulmonary Disease | Group - Multi-Specialty |
| No | 207VX0201X | Allopathic & Osteopathic Physicians | Obstetrics & Gynecology | Gynecologic Oncology | Group - Multi-Specialty |
| No | 2080N0001X | Allopathic & Osteopathic Physicians | Pediatrics | Neonatal-Perinatal Medicine | Group - Multi-Specialty |
| No | 2085R0001X | Allopathic & Osteopathic Physicians | Radiology | Radiation Oncology | Group - Multi-Specialty |
| No | 208600000X | Allopathic & Osteopathic Physicians | Surgery | Group - Multi-Specialty | |
| No | 208800000X | Allopathic & Osteopathic Physicians | Urology | Group - Multi-Specialty | |
| No | 208G00000X | Allopathic & Osteopathic Physicians | Thoracic Surgery (Cardiothoracic Vascular Surgery) | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| MT | 011002409 | Medicare PIN | |
| 011002409 | Medicare PIN |
