Provider Demographics
NPI:1043469513
Name:BENEFIS MEDICAL GROUP
Entity type:Organization
Organization Name:BENEFIS MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-455-2920
Mailing Address - Street 1:P.O. BOX 6010
Mailing Address - Street 2:
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6010
Mailing Address - Country:US
Mailing Address - Phone:406-455-2900
Mailing Address - Fax:406-455-2902
Practice Address - Street 1:1117 29TH STREET SOUTH
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-5306
Practice Address - Country:US
Practice Address - Phone:406-455-8150
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-09
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT7270207RH0003X
MT101452080P0207X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No2080P0207XAllopathic & Osteopathic PhysiciansPediatricsPediatric Hematology-OncologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT830006549OtherRR
MT0000372861OtherW-BCBS
MT500018658OtherRR
MTP00386826OtherMEDICARE RAILROAD
MTP00393761OtherRR
MT0000093788OtherH-BCBS
MT0000094908OtherB-BCBS
MT0000099035OtherBCBS
MT0000372861OtherW-BCBS
MT011002263Medicare PIN
MT011002249Medicare PIN
MT011000327Medicare PIN
MTP00393761OtherRR
MT830006549OtherRR
MT011000873Medicare PIN
MT0000094908OtherB-BCBS
MT011000125Medicare PIN
MT000085424Medicare PIN