1962913095 NPI number — MRS. MARGARET MECHELLE MONTGOMERY RMA/HHA

Table of content: MRS. MARGARET MECHELLE MONTGOMERY RMA/HHA (NPI 1962913095)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1962913095 NPI number — MRS. MARGARET MECHELLE MONTGOMERY RMA/HHA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
MARGARET
Provider Middle Name:
MECHELLE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RMA/HHA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MANN
Provider Other First Name:
MARGARET
Provider Other Middle Name:
MECHELLE
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1962913095
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/16/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12939 LAKE VISTA DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GIBSONTON
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33534-3900
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-464-0828
Provider Business Mailing Address Fax Number:
813-373-5448

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12939 LAKE VISTA DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GIBSONTON
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33534-3900
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
813-464-0828
Provider Business Practice Location Address Fax Number:
813-373-5448
Provider Enumeration Date:
10/16/2017

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: 374U00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 347C00000X , with the licence number: M532573655270 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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