Healthcare Provider Details

I. General information

NPI: 1932395084
Provider Name (Legal Business Name): TERRY A. SMITH M.C.P.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/22/2007
Last Update Date: 10/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 SPRUCE ST
SUPERIOR MT
59872-9680
US

IV. Provider business mailing address

310 SPRUCE ST PO BOX 340
SUPERIOR MT
59872-9680
US

V. Phone/Fax

Practice location:
  • Phone: 406-822-4100
  • Fax:
Mailing address:
  • Phone: 406-822-4100
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number7350
License Number StateMT

VIII. Authorized Official

Name: DR. TERRY ALLEN SMITH
Title or Position: OWNER
Credential: D.O.
Phone: 406-822-4100