Provider Demographics
NPI:1336179316
Name:MONTGOMERY CARDIOVASCULAR ASSOCIATES, P.C.
Entity type:Organization
Organization Name:MONTGOMERY CARDIOVASCULAR ASSOCIATES, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:D
Authorized Official - Last Name:RONEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-280-1520
Mailing Address - Street 1:PO BOX 241587
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36124-1587
Mailing Address - Country:US
Mailing Address - Phone:334-280-1500
Mailing Address - Fax:334-280-1600
Practice Address - Street 1:273 WINTON M BLOUNT LOOP
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36117-3507
Practice Address - Country:US
Practice Address - Phone:334-280-1500
Practice Address - Fax:334-280-1600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALJ658OtherMEDICARE COMMON PAY NUMBE
ALI245OtherMEDICARE COMMON PAY NUMBE
ALC137OtherMEDICARE COMMON PAY NUMBE
ALI244OtherMEDICARE COMMON PAY NUMBE