Provider Demographics
NPI:1780123109
Name:MONTGOMERY ACCIDENT AND INJURY CENTER, INC
Entity type:Organization
Organization Name:MONTGOMERY ACCIDENT AND INJURY CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:PHILLIPS
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:334-270-9940
Mailing Address - Street 1:2900 ZELDA RD
Mailing Address - Street 2:STE B
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36106
Mailing Address - Country:US
Mailing Address - Phone:334-270-9940
Mailing Address - Fax:334-270-9939
Practice Address - Street 1:2900 ZELDA RD
Practice Address - Street 2:STE B
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36106
Practice Address - Country:US
Practice Address - Phone:334-270-9940
Practice Address - Fax:334-270-9939
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-02-17
Last Update Date:2017-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL-148444363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty