Provider Demographics
NPI:1326210923
Name:DRS. MITCHELL & MONTGOMERY
Entity Type:Organization
Organization Name:DRS. MITCHELL & MONTGOMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:DORA
Authorized Official - Middle Name:
Authorized Official - Last Name:BURLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-686-5440
Mailing Address - Street 1:2508 BERT KOUNS LOOP STE 401
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71118-3154
Mailing Address - Country:US
Mailing Address - Phone:318-686-5440
Mailing Address - Fax:318-686-0624
Practice Address - Street 1:2508 BERT KOUNS LOOP STE 401
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71118-3154
Practice Address - Country:US
Practice Address - Phone:318-686-5440
Practice Address - Fax:318-686-0624
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2008-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LADA2431OtherRAILROAD MEDICARE