Provider Demographics
NPI:1013164987
Name:BENEFIS HEALTHCARE PRACTITIONERS, PC
Entity Type:Organization
Organization Name:BENEFIS HEALTHCARE PRACTITIONERS, PC
Other - Org Name:BPA HAVRE
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:JOSEPH
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 1:40 13TH ST W
Practice Address - Street 2:
Practice Address - City:HAVRE
Practice Address - State:MT
Practice Address - Zip Code:59501-5215
Practice Address - Country:US
Practice Address - Phone:406-265-7831
Practice Address - Fax:406-265-1651
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2008-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT10706207RH0000X
MT101452080P0207X
NH117652085R0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0000XAllopathic & Osteopathic PhysiciansInternal MedicineHematologyGroup - Multi-Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT0000093788OtherBCBS
MT0000093858OtherBCBS
0000099035OtherBCBS
MT1417953019Medicaid
MT1619067295Medicaid
MT1447275870Medicaid
MT96516OtherBLUECROSS BLUESHIELD
MTPOO393761OtherMEDICARE RAILROAD
MT96516OtherBLUECROSS BLUESHIELD
MT1417953019Medicaid