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General NPI Number Information
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NPI Number | 1144291923
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Entity Type | Organization
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Legal Business Name | INTERVENTIONAL THERAPEUTICS INSTITUTE, LLC
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Dates
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Enumeration Date | 01/30/2006
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Last Update Date | 05/17/2022
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Provider Practice Location Address
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Address Line | 5102 N DAVIS HWY
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City | PENSACOLA
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State | FL
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Zip | 32503-2030
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Country | US
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Telephone | 855-527-7246
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Fax | 855-527-7246
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Provider Business Mailing Address
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Address Line | 201 DEFENSE HWY STE 205
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City | ANNAPOLIS
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State | MD
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Zip | 21401-7096
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Country | US
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Telephone | 855-527-7246
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Fax | 833-810-1165
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Authorized Official
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Title or Position | REGIONAL MEDICAL DIRECTOR
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Name | KACEY A MONTGOMERY
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Credential | M.D.
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Telephone | 850-791-6895
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 1241
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License Number State | FL
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