Organization
MONTGOMERY MEDCORP, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ANGELA SIZEMORE (BUSINESS OFFICE DIRECTOR)
(304) 442-1251
Entity
Organization
Contact information
Practice address
401 6TH AVE, MONTGOMERY, WV 25136-2116
(304) 442-5151
Mailing address
401 6TH AVE, MONTGOMERY, WV 25136-2116
(304) 442-5151
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
4000066000
—
WV
Enumeration date
10/03/2006
Last updated
08/22/2020
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