MEDICARE: WILLIAM BELL MONTGOMERY, LLC

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	310400000X	Assisted Living Facility

General Provider Information

NPI Number	:	1972768414
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILLIAM BELL MONTGOMERY, LLC

Provider Business Mailing Address
First Line	:	4348 OLD HIGHWAY 12
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-5922
Country	:	US
Telephone Number	:	573-471-1113
Fax Number	:

Provider Business Practice Location Address
First Line	:	4348 OLD HIGHWAY 12
Second Line	:
City	:	STARKVILLE
State	:	MS
Zip	:	39759-5922
Country	:	US
Telephone Number	:	573-471-1113
Fax Number	:

Authorized Official
Title or Position	:	MANAGER
Name	:	KYLE TIMOTHY SCHADE
Credential	:
Telephone Number	:	573-471-1113

Provider Enumeration Date	:	07/24/2008
Last Update Date	:	03/10/2026

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