Healthcare Provider Details

I. General information

NPI: 1043469513
Provider Name (Legal Business Name): BENEFIS MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/09/2008
Last Update Date: 11/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1117 29TH STREET SOUTH
GREAT FALLS MT
59405-5306
US

IV. Provider business mailing address

P.O. BOX 6010
GREAT FALLS MT
59406-6010
US

V. Phone/Fax

Practice location:
  • Phone: 406-455-8150
  • Fax:
Mailing address:
  • Phone: 406-455-2900
  • Fax: 406-455-2902

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number7270
License Number StateMT
# 2
Primary TaxonomyN
Taxonomy Code2080P0207X
TaxonomyPediatric Hematology & Oncology Physician
License Number10145
License Number StateMT

VIII. Authorized Official

Name: DR. JERRY W. SPEER
Title or Position: PRESIDENT
Credential: MD
Phone: 406-455-2920