1659408326 NPI number — BENEFIS HEALTHCARE PRACTITIONERS

Table of content: (NPI 1659408326)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659408326 NPI number — BENEFIS HEALTHCARE PRACTITIONERS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BENEFIS HEALTHCARE 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:
PRIMARY CARE PEDIATRICS
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:
1659408326
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/24/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
P.O. BOX 6010
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 203
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:
406-727-0590
Provider Business Practice Location Address Fax Number:
406-455-2815
Provider Enumeration Date:
02/28/2007

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: 208000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: 8796 , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1659408326 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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