MEDICARE: MONTANA MEDICAL SUPPLY, LLC

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	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1891026241
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTANA MEDICAL SUPPLY, LLC

Provider Business Mailing Address
First Line	:	PO BOX 80041
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59108-0041
Country	:	US
Telephone Number	:	916-799-6992
Fax Number	:

Provider Business Practice Location Address
First Line	:	1911 22ND AVE S
Second Line	:
City	:	GREAT FALLS
State	:	MT
Zip	:	59405-6425
Country	:	US
Telephone Number	:	916-799-6992
Fax Number	:

Authorized Official
Title or Position	:	MEMBER
Name	:	MR. MAURICIO TERRAZAS JR.
Credential	:
Telephone Number	:	916-799-6992

Provider Enumeration Date	:	01/25/2010
Last Update Date	:	12/01/2010

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