Provider Demographics
NPI:1891682753
Name:JACK C. MONTGOMERY VA MEDICAL CENTER
Entity type:Organization
Organization Name:JACK C. MONTGOMERY VA MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEVIN
Authorized Official - Middle Name:TAYLOR
Authorized Official - Last Name:TREVINO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:918-616-6667
Mailing Address - Street 1:1011 HONOR HEIGHTS DR
Mailing Address - Street 2:
Mailing Address - City:MUSKOGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74401-1318
Mailing Address - Country:US
Mailing Address - Phone:918-577-3551
Mailing Address - Fax:
Practice Address - Street 1:1011 HONOR HEIGHTS DR
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74401-1318
Practice Address - Country:US
Practice Address - Phone:918-577-3551
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-06-23
Last Update Date:2025-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care