MR. TOM MONTGOMERY III (NPI# 1205225117) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1205225117 |
| Entity Type | Individual |
| Full Name | MR. TOM MONTGOMERY III |
| Practice Address |
1929 Betty Jane Ln Muskogee OK 74403-1581 |
| Practice Telephone | 9186839407 |
| Mailing Telephone | 9186839407 |
| Enumeration Date | 2015-01-15 |
| Last Update Date | 2015-01-15 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 376G00000X | Nursing Home Administrator | 2286 | OK | Nursing Service Related Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| OK | 200106120A | 05 | |
| OK | MEDICARE PROVIDER ENROLLMENT | 375174 | 01 |
| Street Address |
1929 BETTY JANE LN |
| City | MUSKOGEE |
| State | OK |
| Zip Code | 74403-1581 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1861945602 | Mccall Dental Studio | Dentist | 2214 Chandler Rd, Muskogee, OK 74403 | 2016-07-28 |
| 1386047256 | Dr. Penny B. Smythe, Inc., PC | Optometrist | 1157 N. York St., Muskogee, OK 74403 | 2014-10-06 |
| 1841563210 | Peggy Hanson | Social Worker | 503 E. Cincinnati Avenue, Muskogee, OK 74403 | 2012-02-16 |
| 1467736736 | Crystal S Richardson | Behavioral Analyst | 502 E Cincinnati Ave., Muskogee, OK 74403 | 2011-10-05 |
| 1114109816 | Jennifer Irene Newton | Dietitian, Registered | 1001 S. 41st Street East, Muskogee, OK 74403 | 2007-12-04 |
| 1922290899 | Casey Farmer | Counselor | 501 Fredonia, Muskogee, OK 74403 | 2007-08-15 |
| 1609068501 | Brenda Lawson | Counselor | 501 Fredonia St, Muskogee, OK 74403 | 2007-08-14 |
| 1689888661 | Christy Janet Coggins | Physical Therapy Assistant | 3310 Chandler Road, Muskogee, OK 74403 | 2007-05-09 |
| 1376765412 | Magnolia Gardens | Assisted Living Facility | 3211 Chandler Road, Muskogee, OK 74403 | 2007-05-02 |
| 1841411972 | Country Gardens Assisted Living, LLC | Assisted Living Facility | 611 S. Country Club Road, Muskogee, OK 74403 | 2007-05-02 |
| Find all providers in zip 74403 | ||||
| Taxonomy Code | 376G00000X |
| Grouping | Nursing Service Related Providers |
| Classification | Nursing Home Administrator |
| An individual, often licensed by the state, who is responsible for the management of a nursing home. |
| Notes: Source: Lexikon: Dictionary of Health Care Terms, Organizations, and Acronyms for the Era of Reform, Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, IL, 1994, p. 552. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1003452723 | Charonda Kaye Jordan | Nursing Home Administrator | 3803 S 79th East Ave # 100, Tulsa, OK 74145-3218 | 2019-11-18 |
| 1851944235 | Ermie Clintina Williams | Nursing Home Administrator | 2132 Ne 36th St, Oklahoma City, OK 73111-5306 | 2019-07-24 |
| 1316395593 | Adekunle Francis | Nursing Home Administrator | 7110 S Utica Ave, Apt 601, Tulsa, OK 74136-5157 | 2016-05-30 |
| 1518257492 | Victor Ikemefula Ukonu | Nursing Home Administrator | 4045 Nw 64st, Oklahoma, OK 73116 | 2011-04-13 |
| 1548762982 | Lloyd Dean Hilburn | Nursing Home Administrator | 225 N. Broadway, P.o. Box 99, Carnegie, OK 73015 | 2018-03-01 |
| 1548633142 | Edna Keaton | Nursing Home Administrator | 421 W South Ave, Vinita, OK 74301-4143 | 2015-11-04 |
Please comment or provide details below to improve the information on MR. TOM MONTGOMERY III.
| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.