Provider Demographics
NPI:1346489598
Name:BENEFIS MEDICAL GROUP
Entity type:Organization
Organization Name:BENEFIS MEDICAL GROUP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SPEER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-455-2920
Mailing Address - Street 1:P.O. BOX 6010
Mailing Address - Street 2:BENEFIS PHYSICIAN ASSOCIATES
Mailing Address - City:GREAT FALLS
Mailing Address - State:MT
Mailing Address - Zip Code:59406-6010
Mailing Address - Country:US
Mailing Address - Phone:406-455-2900
Mailing Address - Fax:406-455-2902
Practice Address - Street 1:500 15TH AVENUE SOUTH
Practice Address - Street 2:GROUND FLOOR
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-4304
Practice Address - Country:US
Practice Address - Phone:406-455-2900
Practice Address - Fax:406-455-2902
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BENEFIS HEALTH SYSTEM
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-11
Last Update Date:2010-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8503207Q00000X
MT11418207RC0000X, 207RI0011X
MT10267207RC0200X
MT11973207RE0101X
MT10557207RG0300X
MT4766207RP1001X
MT11382207VX0201X
MT118122080N0001X
MT118402085R0001X
MT11426208600000X
MT10564208800000X
MT9761208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Multi-Specialty
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care MedicineGroup - Multi-Specialty
No207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & MetabolismGroup - Multi-Specialty
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric MedicineGroup - Multi-Specialty
No207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional CardiologyGroup - Multi-Specialty
No207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary DiseaseGroup - Multi-Specialty
No207VX0201XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecologic OncologyGroup - Multi-Specialty
No2080N0001XAllopathic & Osteopathic PhysiciansPediatricsNeonatal-Perinatal MedicineGroup - Multi-Specialty
No2085R0001XAllopathic & Osteopathic PhysiciansRadiologyRadiation OncologyGroup - Multi-Specialty
No208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Multi-Specialty
No208800000XAllopathic & Osteopathic PhysiciansUrologyGroup - Multi-Specialty
No208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT011002409Medicare PIN
011002409Medicare PIN