Provider Demographics
NPI:1164220729
Name:MONTGOMERY KEETON INFUSION CENTER, LLC.
Entity type:Organization
Organization Name:MONTGOMERY KEETON INFUSION CENTER, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MELISSA
Authorized Official - Middle Name:KEETON
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:256-415-6542
Mailing Address - Street 1:503 W STATE ST STE A18
Mailing Address - Street 2:
Mailing Address - City:MUSCLE SHOALS
Mailing Address - State:AL
Mailing Address - Zip Code:35661-2861
Mailing Address - Country:US
Mailing Address - Phone:256-415-6542
Mailing Address - Fax:256-415-6415
Practice Address - Street 1:503 W STATE ST STE A18
Practice Address - Street 2:
Practice Address - City:MUSCLE SHOALS
Practice Address - State:AL
Practice Address - Zip Code:35661-2861
Practice Address - Country:US
Practice Address - Phone:256-415-6542
Practice Address - Fax:256-415-6415
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-07
Last Update Date:2025-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QI0500XAmbulatory Health Care FacilitiesClinic/CenterInfusion Therapy