MEDICARE: BRETT RUSSELL BENNION MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Y00000X	Otolaryngology Physician	8624	MT

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	040014113	OTHER		RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	000018941	OTHER	MT	BLUE CROSS
5	18595	OTHER	ND	BLUE CROSS

General Provider Information

NPI Number	:	1275616104
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BRETT RUSSELL BENNION MD

Provider Business Mailing Address
First Line	:	214 14TH AVE SW
Second Line	:	SUITE 101
City	:	SIDNEY
State	:	MT
Zip	:	59270
Country	:	US
Telephone Number	:	406-488-2380
Fax Number	:	406-488-2382

Provider Business Practice Location Address
First Line	:	214 14TH AVE SW
Second Line	:	SUITE 101
City	:	SIDNEY
State	:	MT
Zip	:	59270
Country	:	US
Telephone Number	:	406-488-2380
Fax Number	:	406-488-2382

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/23/2006
Last Update Date	:	12/09/2022

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Directions to “ BRETT RUSSELL BENNION MD” Practice Location

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