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General NPI Number Information
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NPI Number | 1659961431
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Entity Type | Organization
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Legal Business Name | MONTGOMERY FAMILY CARE LLC
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Dates
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Enumeration Date | 01/25/2021
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Last Update Date | 06/29/2021
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Provider Practice Location Address
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Address Line | 125 FOXGLOVE DR STE B
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City | MOUNT STERLING
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State | KY
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Zip | 40353-9735
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Country | US
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Telephone | 859-432-5641
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Fax |
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Provider Business Mailing Address
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Address Line | 125 FOXGLOVE DR STE B
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City | MOUNT STERLING
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State | KY
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Zip | 40353-9735
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Country | US
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Telephone | 859-520-9292
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Fax | 859-520-9004
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Authorized Official
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Title or Position | MD/OWNER
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Name | TAUFIK KASSIS
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Credential | MD
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Telephone | 859-520-9292
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 261QR1300X
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Taxonomy Name | Rural Health Clinic/Center
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License Number |
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License Number State |
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