Provider Demographics
NPI:1659528461
Name:MONTGOMERY COUNTY MANAGEMENT COMPANY, LLC
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY MANAGEMENT COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:CARROL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAGLE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:936-760-7832
Mailing Address - Street 1:9305 PINECROFT
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77380
Mailing Address - Country:US
Mailing Address - Phone:281-943-2456
Mailing Address - Fax:281-943-2453
Practice Address - Street 1:9305 PINECROFT
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77380
Practice Address - Country:US
Practice Address - Phone:281-943-2456
Practice Address - Fax:281-943-2453
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-22
Last Update Date:2012-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXP00816054OtherRAILROAD MEDICARE NUMBER
TX45C0001488OtherCCN
TX45C0001488OtherCCN