Provider Demographics
NPI:1578517918
Name:CHRISTOPHER R. MONTGOMERY, MD
Entity Type:Organization
Organization Name:CHRISTOPHER R. MONTGOMERY, MD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIN ASST
Authorized Official - Prefix:
Authorized Official - First Name:NINA
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BRADEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-686-4133
Mailing Address - Street 1:2400 LUCY LEE PKWY
Mailing Address - Street 2:SUITE B
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2429
Mailing Address - Country:US
Mailing Address - Phone:573-785-0566
Mailing Address - Fax:573-686-7752
Practice Address - Street 1:2400 LUCY LEE PKWY
Practice Address - Street 2:SUITE B
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2429
Practice Address - Country:US
Practice Address - Phone:573-785-0566
Practice Address - Fax:573-686-7752
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-20
Last Update Date:2008-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR1300XAmbulatory Health Care FacilitiesClinic/CenterRural Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO263957Medicare Oscar/Certification