MEDICARE: GREGORY R MONTGOMERY SR

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	343900000X	Non-emergency Medical Transport (VAN)

General Provider Information

NPI Number	:	1598659773
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	GREGORY R MONTGOMERY SR

Provider Business Mailing Address
First Line	:	5551 OAKWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2333
Country	:	US
Telephone Number	:	216-333-3680
Fax Number	:	216-333-3680

Provider Business Practice Location Address
First Line	:	5551 OAKWOOD AVE
Second Line	:
City	:	MAPLE HEIGHTS
State	:	OH
Zip	:	44137-2333
Country	:	US
Telephone Number	:	216-333-3680
Fax Number	:	216-333-3680

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/04/2025
Last Update Date	:	06/04/2025

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Directions to “ GREGORY R MONTGOMERY SR ” Practice Location

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