1568431443 NPI number — MONTGOMERY MEDICAL SERVICES, PLLC

Table of content: (NPI 1568431443)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568431443 NPI number — MONTGOMERY MEDICAL SERVICES, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY MEDICAL SERVICES, PLLC
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:
MONTGOMERY CANCER CENTER
Provider Other Organization Name Type Code:
3
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:
1568431443
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/23/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 704
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MT STERLING
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40353-0704
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
859-499-1000
Provider Business Mailing Address Fax Number:
859-499-4181

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
644 MAYSVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 10
Provider Business Practice Location Address City Name:
MT STERLING
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40353-9464
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
859-499-1000
Provider Business Practice Location Address Fax Number:
859-499-4181
Provider Enumeration Date:
03/14/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ZAYDAN
Authorized Official First Name:
MUHAMMAD-ALI
Authorized Official Middle Name:
AKRAM
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
859-499-1000

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  37117 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363LF0000X , with the licence number: 3004221 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 65941130 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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