Provider Demographics
NPI:1487782322
Name:BRETT R BENNION, MD, PC
Entity type:Organization
Organization Name:BRETT R BENNION, MD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:
Authorized Official - Last Name:BENNION
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:406-488-2380
Mailing Address - Street 1:214 14TH AVE SW STE 101
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:MT
Mailing Address - Zip Code:59270-3521
Mailing Address - Country:US
Mailing Address - Phone:406-488-2380
Mailing Address - Fax:406-488-2382
Practice Address - Street 1:214 14TH AVE SW STE 101
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:MT
Practice Address - Zip Code:59270-3521
Practice Address - Country:US
Practice Address - Phone:406-488-2380
Practice Address - Fax:406-488-2382
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-01
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT8624174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
000084277OtherMEDICARE GROUP #
MT0015759Medicaid
ND10976Medicaid
ND18595OtherBLUE CROSS
MT000018941OtherBLUE CROSS
N711308OtherMEDICARE LEGACY