Provider Demographics
NPI:1609553452
Name:MONTGOMERY TELEHEALTH
Entity Type:Organization
Organization Name:MONTGOMERY TELEHEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-813-0806
Mailing Address - Street 1:8838 SEVEN LAKES DR
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-4952
Mailing Address - Country:US
Mailing Address - Phone:423-813-0806
Mailing Address - Fax:
Practice Address - Street 1:8838 SEVEN LAKES DR
Practice Address - Street 2:
Practice Address - City:OOLTEWAH
Practice Address - State:TN
Practice Address - Zip Code:37363-4952
Practice Address - Country:US
Practice Address - Phone:423-813-0806
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-03
Last Update Date:2023-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care