Provider Demographics
NPI:1801572953
Name:MONTGOMERY MEDICAL, INC.
Entity type:Organization
Organization Name:MONTGOMERY MEDICAL, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARCY
Authorized Official - Middle Name:J
Authorized Official - Last Name:FLECKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-569-8100
Mailing Address - Street 1:105 LAUREL VIEW DR
Mailing Address - Street 2:
Mailing Address - City:SMITHFIELD
Mailing Address - State:PA
Mailing Address - Zip Code:15478-8908
Mailing Address - Country:US
Mailing Address - Phone:724-569-8100
Mailing Address - Fax:724-569-8368
Practice Address - Street 1:105 LAUREL VIEW DR
Practice Address - Street 2:
Practice Address - City:SMITHFIELD
Practice Address - State:PA
Practice Address - Zip Code:15478-8908
Practice Address - Country:US
Practice Address - Phone:724-569-8100
Practice Address - Fax:724-569-8368
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY MEDICAL, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-06-23
Last Update Date:2024-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty