Healthcare Provider Details

I. General information

NPI: 1568431443
Provider Name (Legal Business Name): MONTGOMERY MEDICAL SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2006
Last Update Date: 06/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 MAYSVILLE RD SUITE 10
MT STERLING KY
40353-9464
US

IV. Provider business mailing address

PO BOX 704
MT STERLING KY
40353-0704
US

V. Phone/Fax

Practice location:
  • Phone: 859-499-1000
  • Fax: 859-499-4181
Mailing address:
  • Phone: 859-499-1000
  • Fax: 859-499-4181

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License Number37117
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3004221
License Number StateKY

VIII. Authorized Official

Name: MUHAMMAD-ALI AKRAM ZAYDAN
Title or Position: PHYSICIAN
Credential: MD
Phone: 859-499-1000