Provider Demographics
NPI:1073811006
Name:MONTGOMERY, RONNIE RAY
Entity Type:Individual
Prefix:MR
First Name:RONNIE
Middle Name:RAY
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 OLYMPIC ST
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1017
Mailing Address - Country:US
Mailing Address - Phone:504-469-5375
Mailing Address - Fax:504-469-2900
Practice Address - Street 1:10 OLYMPIC ST
Practice Address - Street 2:
Practice Address - City:KENNER
Practice Address - State:LA
Practice Address - Zip Code:70065-1017
Practice Address - Country:US
Practice Address - Phone:504-469-5375
Practice Address - Fax:504-469-2900
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-28
Last Update Date:2011-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343800000XTransportation ServicesSecured Medical Transport (VAN)
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA68-0567817OtherLLC