Provider Demographics
NPI:1467485201
Name:MONTGOMERY MEDICAL SUPPLY
Entity Type:Organization
Organization Name:MONTGOMERY MEDICAL SUPPLY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-538-9020
Mailing Address - Street 1:11800 PRICES DISTILLERY RD
Mailing Address - Street 2:
Mailing Address - City:DAMASCUS
Mailing Address - State:MD
Mailing Address - Zip Code:20872-1506
Mailing Address - Country:US
Mailing Address - Phone:301-538-9020
Mailing Address - Fax:301-482-1523
Practice Address - Street 1:11800 PRICES DISTILLERY RD
Practice Address - Street 2:
Practice Address - City:DAMASCUS
Practice Address - State:MD
Practice Address - Zip Code:20872-1506
Practice Address - Country:US
Practice Address - Phone:301-538-9020
Practice Address - Fax:301-482-1523
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier