Healthcare Provider Details

I. General information

NPI: 1992100010
Provider Name (Legal Business Name): MONTGOMERY GEN CAHGRP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/31/2014
Last Update Date: 04/12/2023
Certification Date: 04/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 6TH AVE
MONTGOMERY WV
25136-2116
US

IV. Provider business mailing address

401 6TH AVE
MONTGOMERY WV
25136-2116
US

V. Phone/Fax

Practice location:
  • Phone: 304-442-5151
  • Fax: 304-442-7494
Mailing address:
  • Phone: 304-442-5151
  • Fax: 304-442-7494

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. SHERRI MURRAY
Title or Position: CFO
Credential:
Phone: 304-442-1246