Organization
MONTGOMERY MEDICAL ASSOCIATES LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARY JOAN HOLSOPPLE (PRACTICE MANAGER)
(812) 486-2842
Entity
Organization
Contact information
Practice address
542 N 3RD ST, MONTGOMERY, IN 47558-5745
(812) 486-2842
Mailing address
PO BOX 102, MONTGOMERY, IN 47558-0102
(812) 486-2842
(812) 486-2784
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200864610A
—
IN
Enumeration date
09/26/2007
Last updated
05/06/2021
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