Healthcare Provider Details

I. General information

NPI: 1639614902
Provider Name (Legal Business Name): BENJAMIN M PIKE CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/22/2016
Last Update Date: 01/06/2025
Certification Date: 01/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2440 WINNE AVE STE 100
HELENA MT
59601-4913
US

IV. Provider business mailing address

1411 STUART ST
HELENA MT
59601-2331
US

V. Phone/Fax

Practice location:
  • Phone: 406-457-4200
  • Fax:
Mailing address:
  • Phone: 406-440-5004
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number226947
License Number StateMT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: