Provider Demographics
NPI:1487822581
Name:BENEFIS HEALTHCARE PRACTITIONERS
Entity Type:Organization
Organization Name:BENEFIS HEALTHCARE PRACTITIONERS
Other - Org Name:CARDIO WEST SURGERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:REINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-455-4470
Mailing Address - Street 1:2519 13TH AVE S
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59405-5178
Mailing Address - Country:US
Mailing Address - Phone:406-455-4470
Mailing Address - Fax:406-268-0084
Practice Address - Street 1:1300 28TH ST S
Practice Address - Street 2:SUITE 1
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5296
Practice Address - Country:US
Practice Address - Phone:406-455-4333
Practice Address - Fax:406-455-4977
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEFIS HEALTHCARE PRACTITIONERS, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-02-12
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000091628OtherBCBS
MT1073700225Medicaid
MT1205940483Medicaid
MT000091638OtherBCBS
MT011001247Medicare PIN
MT1073700225Medicaid
MT011001341Medicare PIN