Provider Demographics
NPI:1366486664
Name:MONTGOMERY SURGERY ASSOCIATES LLC
Entity Type:Organization
Organization Name:MONTGOMERY SURGERY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-650-2907
Mailing Address - Street 1:830 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7023
Mailing Address - Country:US
Mailing Address - Phone:540-961-1591
Mailing Address - Fax:
Practice Address - Street 1:830 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7023
Practice Address - Country:US
Practice Address - Phone:540-961-1591
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-16
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1366486664Medicaid
DE2036OtherRR MEDICARE
WV3810003897Medicaid
VA1366486664Medicaid