1972703478 NPI number — BENEFIS HEATLHCARE PRACTITIONERS

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972703478 NPI number — BENEFIS HEATLHCARE PRACTITIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENEFIS HEATLHCARE PRACTITIONERS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
AMY ELIZABETH MARTIN, MD
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972703478
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/11/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2519 13TH AVE S
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59405-5178
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-455-4470
Provider Business Mailing Address Fax Number:
406-268-0084

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 13TH AVE S
Provider Second Line Business Practice Location Address:
SUITE 101
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59405-4300
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-455-2821
Provider Business Practice Location Address Fax Number:
406-455-2824
Provider Enumeration Date:
07/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
REINER
Authorized Official First Name:
DANIEL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
CHIEF ADMINISTRATIVE OFFICER
Authorized Official Telephone Number:
406-455-4470

Provider Taxonomy Codes

  • Taxonomy code: 208600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1982650768 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1982650768 . This is a "MBCHP" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 611532402 . This is a "DOL" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 000097536 . This is a "BCBS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".




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