Montgomery, Tom

Montgomery, Tom is an individual health care provider with primary practice located at 1929 Betty Jane Ln , Muskogee OK 74403-1581. He recently has only one registered license in Nursing Service Related Providers / Nursing Home Administrator, which is considered as his primary health care specialty. Montgomery, Tom can be contacted via phone (918) 683-9407.

Contact Information

Primary practice address
1929 Betty Jane Ln Muskogee OK 74403-1581
Phone: (918) 683-9407
Fax:
Website:
Map and Directions

Health care specialties

SpecialtyCodeLicense #State
Nursing Service Related Providers / Nursing Home Administrator 376G00000X 2286 Oklahoma

Profile Details

NPI number 1205225117
LBN Legal business name Montgomery, Tom
Credentials
Entity Individual
Sole proprietor 1 No
Enumeration date Jan 15th, 2015
Last updated Jan 15th, 2015 - about 9 years ago

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1205225117 NPPES
Oklahoma MEDICAID 200106120A
Oklahoma Other 375174

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