1972703478 NPI number — BENEFIS HEATLHCARE PRACTITIONERS

Table of content: (NPI 1972703478)

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:
Provider Other Organization Name Type Code:
6
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".




Copyright © 2007-2025 www.npivalidator.com