Healthcare Provider Details

I. General information

NPI: 1497751077
Provider Name (Legal Business Name): MONTGOMERY MEDICAL EQUIPMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2005
Last Update Date: 06/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 S RICHARDSON ST
MOUNT VERNON GA
30445-2611
US

IV. Provider business mailing address

PO BOX 884
MOUNT VERNON GA
30445-0884
US

V. Phone/Fax

Practice location:
  • Phone: 912-583-2855
  • Fax: 912-583-4945
Mailing address:
  • Phone: 912-583-2855
  • Fax: 912-583-4945

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BX2000X
TaxonomyOxygen Equipment & Supplies (DME)
License Number
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE008058
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License NumberC16488
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: MR. DAVID P. CROWSON
Title or Position: COO
Credential: MT (ASCP)
Phone: 912-583-2855