Organization
MONTGOMERY BAPTIST OUTREACH SERVICES CORPORATION
Active
Other names
MONTGOMERY FAMILY MEDICINE RESIDENCY PROGRAM
Organization subpart
No
Provider details
NPI number
Authorized official
CHRISTINE ELIZABETH BRUTON (CFO)
(334) 273-4258
Entity
Organization
Contact information
Practice address
4371 NARROW LANE RD, SUITE 100, MONTGOMERY, AL 36116-2971
(334) 613-3680
(334) 613-3685
Mailing address
4371 NARROW LANE RD, SUITE 100, MONTGOMERY, AL 36116-2971
(334) 613-3680
(334) 613-3685
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0113048
UNITED HEALTHCARE
AL
05
—
529904250
—
AL
01
—
CC9180
RAILROAD MEDICARE
AL
Enumeration date
05/12/2006
Last updated
04/09/2020
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