Provider Demographics
NPI:1568431443
Name:MONTGOMERY MEDICAL SERVICES, PLLC
Entity Type:Organization
Organization Name:MONTGOMERY MEDICAL SERVICES, PLLC
Other - Org Name:MONTGOMERY CANCER CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:MUHAMMAD-ALI
Authorized Official - Middle Name:AKRAM
Authorized Official - Last Name:ZAYDAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-499-1000
Mailing Address - Street 1:PO BOX 704
Mailing Address - Street 2:
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-0704
Mailing Address - Country:US
Mailing Address - Phone:859-499-1000
Mailing Address - Fax:859-499-4181
Practice Address - Street 1:644 MAYSVILLE RD
Practice Address - Street 2:SUITE 10
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9464
Practice Address - Country:US
Practice Address - Phone:859-499-1000
Practice Address - Fax:859-499-4181
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-14
Last Update Date:2016-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37117207RH0003X
KY3004221363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & OncologyGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65941130Medicaid
KY9141Medicare PIN