Provider Demographics
NPI:1629001870
Name:MONTGOMERY COUNTY
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUE
Authorized Official - Middle Name:E
Authorized Official - Last Name:DRAKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:712-623-4893
Mailing Address - Street 1:1109 HIGHLAND AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:IA
Mailing Address - Zip Code:51566
Mailing Address - Country:US
Mailing Address - Phone:712-623-4893
Mailing Address - Fax:712-623-5714
Practice Address - Street 1:1109 HIGHLAND AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1715
Practice Address - Country:US
Practice Address - Phone:712-623-4893
Practice Address - Fax:712-623-5714
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-09
Last Update Date:2011-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA167075Medicare Oscar/Certification