Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207PE0004X | Emergency Medical Services | F7850 | TX |
NPI | 1083664833 |
---|---|
Provider Name | Eileen Montross |
First Address | College Station, TX 77845-6420 |
Second Address | Bryan, TX 77802-2544 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 26/03/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
B24972 | (02) | TX |