Provider Demographics
NPI:1881830610
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:
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:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4304
Practice Address - Country:US
Practice Address - Phone:406-455-2845
Practice Address - Fax:406-268-0084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-29
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT97612086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular SurgeryGroup - Single Specialty