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General NPI Number Information
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NPI Number | 1972902526
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Entity Type | Organization
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Legal Business Name | S. MONTGOMERY MD & ASSOCIATES BEHAVIORAL HEALTHCARE
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Dates
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Enumeration Date | 08/20/2014
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Last Update Date | 08/20/2014
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Provider Practice Location Address
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Address Line | 620 CARLTON DRIVE SUITE 101
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City | OWENSBORO
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State | KY
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Zip | 42303
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Country | US
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Telephone | 270-688-0636
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Fax | 270-688-0638
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Provider Business Mailing Address
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Address Line | 620 CARLTON DRIVE SUITE 101
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City | OWENSBORO
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State | KY
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Zip | 42303
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Country | US
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Telephone | 270-688-0636
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Fax | 270-688-0638
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Authorized Official
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Title or Position | CEO
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Name | MR. STEPHEN P MONTGOMERY
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Credential | MD
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Telephone | 270-686-0636
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 1001935
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License Number State | KY
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