Provider Demographics
NPI:1891026241
Name:MONTANA MEDICAL SUPPLY, LLC
Entity Type:Organization
Organization Name:MONTANA MEDICAL SUPPLY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:MAURICIO
Authorized Official - Middle Name:
Authorized Official - Last Name:TERRAZAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:916-799-6992
Mailing Address - Street 1:PO BOX 80041
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59108-0041
Mailing Address - Country:US
Mailing Address - Phone:916-799-6992
Mailing Address - Fax:
Practice Address - Street 1:1911 22ND AVE S
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:MT
Practice Address - Zip Code:59405-6425
Practice Address - Country:US
Practice Address - Phone:916-799-6992
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2010-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies