Provider Demographics
NPI:1538221023
Name:MONTGOMERY, WILLIAM SHERMAN (CRNA)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:SHERMAN
Last Name:MONTGOMERY
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2081
Mailing Address - Street 2:
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-2081
Mailing Address - Country:US
Mailing Address - Phone:606-791-0179
Mailing Address - Fax:
Practice Address - Street 1:11203 MAIN ST
Practice Address - Street 2:
Practice Address - City:MARTIN
Practice Address - State:KY
Practice Address - Zip Code:41649-0910
Practice Address - Country:US
Practice Address - Phone:606-285-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-14
Last Update Date:2015-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1039197 696367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65927568Medicaid
KY430018294OtherRAILROAD MEDICARE
KY7100037180Medicaid
KY65927568Medicaid
KY0019368Medicare PIN
KY7100037180Medicaid
KY6649Medicare PIN
KY5490Medicare PIN
KY430018294OtherRAILROAD MEDICARE
KY0664913Medicare PIN
KY0549111Medicare PIN
KY0549032Medicare PIN
KY8001Medicare PIN