MEDICARE: MONTGOMERY CHILDREN'S SPECIALTY CENTER, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility	123323	AL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225347495
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY CHILDREN'S SPECIALTY CENTER, LLC

Provider Business Mailing Address
First Line	:	2853 FORBES
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1307
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2853 FORBES
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36110-1307
Country	:	US
Telephone Number	:	334-262-6421
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	JOSEPH C TUTERA
Credential	:
Telephone Number	:	816-444-0900

Provider Enumeration Date	:	10/05/2010
Last Update Date	:	10/19/2010

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