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Organization

TERRY A. SMITH M.C.P.C.

Active
Other names
ponderosa medical clinic
Organization subpart
No

Provider details

NPI number
Authorized official
DR. TERRY ALLEN SMITH D.O. (OWNER)
(406) 822-4100
Entity
Organization

Contact information

Practice address
310 SPRUCE ST, SUPERIOR, MT 59872-9680
(406) 822-4100
Mailing address
310 SPRUCE ST, PO BOX 340, SUPERIOR, MT 59872-9680
(406) 822-4100

Taxonomy

Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
7350
MT

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
0066521
MT
01
97711
BLUE CROSS BLUE SHIELD
MT
Enumeration date
09/22/2007
Last updated
10/18/2007
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