Organization
STEFAN MONTGOMERY MD FAMILY & SPORTS MEDICINE, PA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STEFAN L MONTGOMERY MD (OWNER)
(803) 531-8500
Entity
Organization
Contact information
Practice address
2850 PELHAM CT, ORANGEBURG, SC 29118-1400
(803) 531-8500
Mailing address
PO BOX 1785, ORANGEBURG, SC 29116-1785
(803) 395-4499
(803) 395-4480
Taxonomy
Speciality
Code
Description
License number
State
207QS0010X
Sports Medicine (Family Medicine) Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000199439
UNISON
SC
01
—
000000199441
UNISON
SC
01
—
20059042
SELECT HEALTH
SC
05
—
272779
—
SC
01
—
7259579
AETNA
SC
01
—
7455015
CIGNA
SC
05
—
DE2500
—
SC
05
—
GP4594
—
SC
Enumeration date
01/08/2007
Last updated
09/08/2008
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