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General NPI Number Information
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NPI Number | 1619061702
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Entity Type | Organization
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Legal Business Name | MONTGOMERY MEDCORP, INC.
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Dates
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Enumeration Date | 10/03/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 401 6TH AVE
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City | MONTGOMERY
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State | WV
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Zip | 25136-2116
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Country | US
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Telephone | 304-442-5151
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Fax |
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Provider Business Mailing Address
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Address Line | 401 6TH AVE
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City | MONTGOMERY
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State | WV
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Zip | 25136-2116
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Country | US
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Telephone | 304-442-5151
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Fax |
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Authorized Official
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Title or Position | BUSINESS OFFICE DIRECTOR
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Name | ANGELA SIZEMORE
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Credential |
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Telephone | 304-442-1251
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number |
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License Number State |
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