Provider Demographics
NPI:1972868636
Name:MONTGOMERY, INC.
Entity type:Organization
Organization Name:MONTGOMERY, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:HIS
Authorized Official - Phone:865-470-4828
Mailing Address - Street 1:10424 KINGSTON PIKE
Mailing Address - Street 2:SUITE 5
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37922-3190
Mailing Address - Country:US
Mailing Address - Phone:865-470-4824
Mailing Address - Fax:
Practice Address - Street 1:10424 KINGSTON PIKE
Practice Address - Street 2:SUITE 5
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37922-3190
Practice Address - Country:US
Practice Address - Phone:865-470-4824
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-09
Last Update Date:2012-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN768332S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332S00000XSuppliersHearing Aid Equipment