1548299365 NPI number — MONTGOMERY PSYCHIATRY, P.C.

Table of content: (NPI 1548299365)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1548299365 NPI number — MONTGOMERY PSYCHIATRY, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY PSYCHIATRY, P.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1548299365
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/23/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1040 LONGFIELD CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONTGOMERY
Provider Business Mailing Address State Name:
AL
Provider Business Mailing Address Postal Code:
36117-8055
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
334-288-9009
Provider Business Mailing Address Fax Number:
334-288-9497

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1040 LONGFIELD CT
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONTGOMERY
Provider Business Practice Location Address State Name:
AL
Provider Business Practice Location Address Postal Code:
36117-8055
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
334-288-9009
Provider Business Practice Location Address Fax Number:
334-288-9497
Provider Enumeration Date:
07/02/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FREEEMAN
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
C.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
334-288-9009

Provider Taxonomy Codes

  • Taxonomy code: 2084P0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 0000 86780 . This is a "PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 260022934 . This is a "MEDICARE RR ID" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: 167529000 . This is a "OWCP PROVIDER NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".
  • Identifier: D378 . This is a "MEDICARE GROUP NUMBER" identifier , issued by the state of ( AL ) . This identifiers is of the category "OTHER".




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