=====================================================
General NPI Number Information
=====================================================
NPI Number | 1013164987
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BENEFIS HEALTHCARE PRACTITIONERS, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/22/2008
-----------------------------------------------------
Last Update Date | 11/11/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 40 13TH ST W
-----------------------------------------------------
City | HAVRE
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59501-5215
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-265-7831
-----------------------------------------------------
Fax | 406-265-1651
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2519 13TH AVE S
-----------------------------------------------------
City | GREAT FALLS
-----------------------------------------------------
State | MT
-----------------------------------------------------
Zip | 59405-5178
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 406-455-4470
-----------------------------------------------------
Fax | 406-268-0084
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF ADMINISTRATIVE OFFICER
-----------------------------------------------------
Name | MR. DANIEL JOSEPH REINER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 406-455-4470
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2080P0207X
-----------------------------------------------------
Taxonomy Name | Pediatric Hematology & Oncology Physician
-----------------------------------------------------
License Number | 10145
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 2085R0001X
-----------------------------------------------------
Taxonomy Name | Radiation Oncology Physician
-----------------------------------------------------
License Number | 11765
-----------------------------------------------------
License Number State | NH
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 207RH0000X
-----------------------------------------------------
Taxonomy Name | Hematology (Internal Medicine) Physician
-----------------------------------------------------
License Number | 10706
-----------------------------------------------------
License Number State | MT
-----------------------------------------------------