Provider Demographics
NPI:1891783767
Name:MONTGOMERY HEALTH OFFICES
Entity Type:Organization
Organization Name:MONTGOMERY HEALTH OFFICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CINDY
Authorized Official - Middle Name:A
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:RNCWHNP
Authorized Official - Phone:505-391-7477
Mailing Address - Street 1:200 W LEA ST
Mailing Address - Street 2:
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-5110
Mailing Address - Country:US
Mailing Address - Phone:505-391-7477
Mailing Address - Fax:505-391-9716
Practice Address - Street 1:200 W LEA ST
Practice Address - Street 2:
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-5110
Practice Address - Country:US
Practice Address - Phone:505-391-7477
Practice Address - Fax:505-391-9716
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMNM00R90POtherBCBS
NMT4781Medicaid
NMS63297Medicare ID - Type Unspecified