MEDICARE: MR. MONTY KITCHENS PA-C

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	363AM0700X	Medical Physician Assistant	997	SC

General Provider Information

NPI Number	:	1740255827
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. MONTY KITCHENS PA-C

Provider Business Mailing Address
First Line	:	516 GATEWOOD DR
Second Line	:
City	:	GREENWOOD
State	:	SC
Zip	:	29646-9201
Country	:	US
Telephone Number	:	864-223-8950
Fax Number	:

Provider Business Practice Location Address
First Line	:	219 N MINE ST
Second Line	:	SUITE A
City	:	MC CORMICK
State	:	SC
Zip	:	29835-9769
Country	:	US
Telephone Number	:	864-852-3336
Fax Number	:	864-852-3339

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2006
Last Update Date	:	07/08/2007

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