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General NPI Number Information
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NPI Number | 1346594801
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Entity Type | Organization
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Legal Business Name | MORGAN COUNTY FAMILY PRACTICE
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Dates
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Enumeration Date | 11/06/2012
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Last Update Date | 11/06/2012
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Provider Practice Location Address
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Address Line | 4279 N STATE ROUTE 376 NW
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City | MCCONNELSVILLE
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State | OH
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Zip | 43756-9145
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Country | US
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Telephone | 740-962-2575
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Fax |
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Provider Business Mailing Address
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Address Line | 4279 N STATE ROUTE 376 NW
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City | MCCONNELSVILLE
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State | OH
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Zip | 43756-9145
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Country | US
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Telephone | 740-962-2575
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Fax |
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Authorized Official
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Title or Position | FNP
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Name | KATHLEEN J MONTGOMERY
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Credential |
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Telephone | 740-818-8416
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number | COA10766NP
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License Number State | OH
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