Healthcare Provider Details

I. General information

NPI: 1316865397
Provider Name (Legal Business Name): JAMES ROBERT MONTGOMERY AEMT
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/08/2026
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 MINERAL RD
HAWTHORNE NV
89415-7875
US

IV. Provider business mailing address

11 SIMPSON TRL
WELLINGTON NV
89444-9236
US

V. Phone/Fax

Practice location:
  • Phone: 775-945-2497
  • Fax:
Mailing address:
  • Phone: 949-705-8968
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146M00000X
TaxonomyIntermediate Emergency Medical Technician
License Number75140
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: