Basic Information
| Provider Information | |||||||||
| NPI: | 1265825434 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AUSTIN | ||||||||
| FirstName: | TERRENCE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5549 US HIGHWAY 93 N | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 598336845 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062734923 | ||||||||
| FaxNumber: | 4063294174 | ||||||||
| Practice Location | |||||||||
| Address1: | 5549 US HIGHWAY 93 N | ||||||||
| Address2: | |||||||||
| City: | FLORENCE | ||||||||
| State: | MT | ||||||||
| PostalCode: | 59833 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4062734923 | ||||||||
| FaxNumber: | 4063294174 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/12/2015 | ||||||||
| LastUpdateDate: | 04/05/2021 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/05/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 51515 | MT | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.