Provider Demographics
NPI:1174602080
Name:MONTGOMERY OBSTETRICAL & GYNECOLOGICAL ASSOCIATES
Entity type:Organization
Organization Name:MONTGOMERY OBSTETRICAL & GYNECOLOGICAL ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:WARREN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-284-2355
Mailing Address - Street 1:2173 NORMANDIE DR
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:AL
Mailing Address - Zip Code:36111-2728
Mailing Address - Country:US
Mailing Address - Phone:334-284-2355
Mailing Address - Fax:334-284-2141
Practice Address - Street 1:2173 NORMANDIE DRIVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:AL
Practice Address - Zip Code:36111-2728
Practice Address - Country:US
Practice Address - Phone:334-284-2355
Practice Address - Fax:334-284-2141
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL17893174400000X
AL24720174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALH64735Medicare UPIN
ALA82388Medicare UPIN
ALJ981Medicare ID - Type UnspecifiedMEDICARE PROVIDER NUMBER