Provider Demographics
NPI:1659408326
Name:BENEFIS HEALTHCARE PRACTITIONERS
Entity Type:Organization
Organization Name:BENEFIS HEALTHCARE PRACTITIONERS
Other - Org Name:PRIMARY CARE PEDIATRICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF ADMINISTRATIVE OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:REINER
Authorized Official - Suffix:
Authorized Official - Credentials:C
Authorized Official - Phone:406-455-4470
Mailing Address - Street 1:P.O. BOX 6010
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 1:400 13TH AVE S
Practice Address - Street 2:SUITE 203
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4300
Practice Address - Country:US
Practice Address - Phone:406-727-0590
Practice Address - Fax:406-455-2815
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEFIS HEALTHCARE PRACTITIONERS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-28
Last Update Date:2008-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
208000000X
MT8796208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1659408326Medicaid