Healthcare Provider Details

I. General information

NPI: 1326203134
Provider Name (Legal Business Name): BENEFIS SLETTEN HI-LINE CANCER CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2008
Last Update Date: 07/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 13TH ST W
HAVRE MT
59501-5215
US

IV. Provider business mailing address

PO BOX 5096
GREAT FALLS MT
59403-5096
US

V. Phone/Fax

Practice location:
  • Phone: 406-262-6000
  • Fax:
Mailing address:
  • Phone: 406-455-5000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QX0203X
TaxonomyRadiation Oncology Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEVE A BALLOCK
Title or Position: CFO/VP
Credential:
Phone: 406-455-5000