Individual
MANDRILL DEANGELO MONTGOMERY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CRNA
Contact information
Practice address
701 GROVE RD, GREENVILLE, SC 29605-5611
(864) 454-7111
(864) 455-6441
Mailing address
1 INDEPENDENCE PT, SUITE 212, GREENVILLE, SC 29615-4545
(864) 797-6307
(864) 797-6198
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
101035
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
57-6007863
TAX ID
SC
Enumeration date
04/16/2008
Last updated
03/19/2014
About Stedi
Stedi is the only programmable healthcare clearinghouse. You can use Stedi's APIs to process eligibility checks, claims, remits, and more.
Contact us