Provider Demographics
NPI:1417087727
Name:MATHIS, TERRY LEE VIII
Entity Type:Individual
Prefix:MR
First Name:TERRY
Middle Name:LEE
Last Name:MATHIS
Suffix:VIII
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35500 PMB 227
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59107-5500
Mailing Address - Country:US
Mailing Address - Phone:406-670-2079
Mailing Address - Fax:406-248-3430
Practice Address - Street 1:3914 BARRY DR
Practice Address - Street 2:
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-4703
Practice Address - Country:US
Practice Address - Phone:406-670-2079
Practice Address - Fax:406-248-3430
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-06
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT5605119Medicaid