Provider Demographics
NPI:1932191632
Name:COUNTWAY, THOMAS M (DPM)
Entity Type:Individual
Prefix:DR
First Name:THOMAS
Middle Name:M
Last Name:COUNTWAY
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2900 12TH AVE N
Mailing Address - Street 2:SUITE 140W
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59101-7506
Mailing Address - Country:US
Mailing Address - Phone:406-238-6540
Mailing Address - Fax:406-238-6599
Practice Address - Street 1:2900 12TH AVE N
Practice Address - Street 2:SUITE 140W
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59101-7506
Practice Address - Country:US
Practice Address - Phone:406-238-6540
Practice Address - Fax:406-238-6599
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2008-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT100213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT000091878OtherBLUE CROSS BLUE SHIELD
MT480028285OtherRAILROAD MEDICARE
MT390429Medicaid
MTT11085Medicare UPIN
MT390429Medicaid