Provider Demographics
NPI:1639614902
Name:PIKE, BENJAMIN M (CRNA)
Entity type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:M
Last Name:PIKE
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1411 STUART ST
Mailing Address - Street 2:
Mailing Address - City:HELENA
Mailing Address - State:MT
Mailing Address - Zip Code:59601-2331
Mailing Address - Country:US
Mailing Address - Phone:406-440-5004
Mailing Address - Fax:
Practice Address - Street 1:2440 WINNE AVE STE 100
Practice Address - Street 2:
Practice Address - City:HELENA
Practice Address - State:MT
Practice Address - Zip Code:59601-4913
Practice Address - Country:US
Practice Address - Phone:406-457-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-12-22
Last Update Date:2025-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT226947367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered