Provider Demographics
NPI:1881675536
Name:MONTGOMERY FAMILY MEDICINE, PC
Entity Type:Organization
Organization Name:MONTGOMERY FAMILY MEDICINE, PC
Other - Org Name:MONTGOMERY FAMILY MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFF
Authorized Official - Middle Name:
Authorized Official - Last Name:SENFT
Authorized Official - Suffix:
Authorized Official - Credentials:CMPE
Authorized Official - Phone:334-396-9100
Mailing Address - Street 1:PO BOX 240369
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-0369
Mailing Address - Country:US
Mailing Address - Phone:334-396-9100
Mailing Address - Fax:334-396-9110
Practice Address - Street 1:8190 SEATON PL
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36116-7204
Practice Address - Country:US
Practice Address - Phone:334-396-9100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-09
Last Update Date:2009-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH125Medicare ID - Type UnspecifiedGROUP NUMBER