1124026679 NPI number — SHERI DAWN MONTGOMERY M.D.

Table of content: SHERI DAWN MONTGOMERY M.D. (NPI 1124026679)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1124026679 NPI number — SHERI DAWN MONTGOMERY M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
SHERI
Provider Middle Name:
DAWN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KOZAR
Provider Other First Name:
SHERI
Provider Other Middle Name:
D.
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1124026679
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/04/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 933
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HENDERSON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42419-0933
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-471-1591
Provider Business Mailing Address Fax Number:
812-471-6650

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1305 N ELM ST
Provider Second Line Business Practice Location Address:
ER
Provider Business Practice Location Address City Name:
HENDERSON
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42420-2783
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-467-7766
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X , with the licence number:  01048937 , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207P00000X , with the licence number: 38356 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200148170 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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