NPIMap

Organization Active NPI

Montgomery Family Clinic

  • Primary Care Clinic/Center
  • Madison, MS
National Provider Identifier
1235429648
Registry record updated Apr 19, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Primary Care Clinic/CenterTaxonomy code 261QP2300X
License
R524174 Issued in MS
Legal business name
MONTGOMERY FAMILY CLINIC
Practice address
122 Weisenberger Rd
Madison, MS 39110-7993
Phone
(601) 790-9098
Fax
(601) 790-9098
NPI assigned
Apr 19, 2011
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 19, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Susan L Montgomery, DNP, RN, FNP-DC
Title
Owner/Provider
Phone
(601) 790-9098

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Primary Care Clinic/Center 261QP2300X R524174 MS Primary

Addresses

Primary practice location

122 Weisenberger Rd
Madison, MS 39110-7993

Mailing address

122 Weisenberger Rd
Madison, MS 39110-7993
Phone (601) 790-9098

National Provider Directory

National Provider Directory

Locations

122 Weisenberger Rd
Gluckstadt, MS 39110
Phone (601) 790-9098

Practitioners & affiliated clinicians

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1303171200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1303171200000",
    "number": "1235429648",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "122 WEISENBERGER RD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107993",
            "telephone_number": "601-790-9098",
            "fax_number": "601-790-9098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "122 WEISENBERGER RD",
            "city": "MADISON",
            "state": "MS",
            "postal_code": "391107993",
            "telephone_number": "601-790-9098",
            "fax_number": "601-790-9098"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY FAMILY CLINIC",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-04-19",
        "last_updated": "2011-04-19",
        "status": "A",
        "authorized_official_last_name": "MONTGOMERY",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "L",
        "authorized_official_title_or_position": "OWNER/PROVIDER",
        "authorized_official_telephone_number": "601-790-9098",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "DNP, RN, FNP-DC"
    },
    "taxonomies": [
        {
            "code": "261QP2300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Primary Care",
            "state": "MS",
            "license": "R524174",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Madison, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 19, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.