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General NPI Number Information
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NPI Number | 1770534901
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Entity Type | Organization
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Legal Business Name | MONTGOMERY BAPTIST OUTREACH SERVICES CORPORATION
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Dates
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Enumeration Date | 05/12/2006
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Last Update Date | 04/09/2020
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Provider Practice Location Address
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Address Line | 4371 NARROW LANE RD SUITE 100
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City | MONTGOMERY
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State | AL
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Zip | 36116-2971
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Country | US
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Telephone | 334-613-3680
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Fax | 334-613-3685
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Provider Business Mailing Address
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Address Line | 4371 NARROW LANE RD SUITE 100
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City | MONTGOMERY
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State | AL
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Zip | 36116-2971
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Country | US
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Telephone | 334-613-3680
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Fax | 334-613-3685
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Authorized Official
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Title or Position | CFO
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Name | CHRISTINE ELIZABETH BRUTON
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Credential |
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Telephone | 334-273-4258
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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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