MEDICARE: MONTGOMERY MEDICAL EQUIPMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332BX2000X	Oxygen Equipment & Supplies (DME)		GA
2	333600000X	Pharmacy	PHRE008058	GA
3	335E00000X	Prosthetic/Orthotic Supplier	C16488	GA
4	332BP3500X	Parenteral & Enteral Nutrition Supplies (DME)
5	332B00000X	Durable Medical Equipment & Medical Supplies

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1497751077
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY MEDICAL EQUIPMENT, INC.

Provider Business Mailing Address
First Line	:	PO BOX 884
Second Line	:
City	:	MOUNT VERNON
State	:	GA
Zip	:	30445-0884
Country	:	US
Telephone Number	:	912-583-2855
Fax Number	:	912-583-4945

Provider Business Practice Location Address
First Line	:	103 S RICHARDSON ST
Second Line	:
City	:	MOUNT VERNON
State	:	GA
Zip	:	30445-2611
Country	:	US
Telephone Number	:	912-583-2855
Fax Number	:	912-583-4945

Authorized Official
Title or Position	:	COO
Name	:	MR. DAVID P. CROWSON
Credential	:	MT (ASCP)
Telephone Number	:	912-583-2855

Provider Enumeration Date	:	06/28/2005
Last Update Date	:	06/20/2012

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Directions to “MONTGOMERY MEDICAL EQUIPMENT, INC. ” Practice Location

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