Provider Demographics
NPI:1417904921
Name:MONTEREY MEDICAL HEALTH SERVICES INC
Entity Type:Organization
Organization Name:MONTEREY MEDICAL HEALTH SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:NONE
Authorized Official - Last Name:ELLIOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-530-5000
Mailing Address - Street 1:PO BOX 746
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34995-0746
Mailing Address - Country:US
Mailing Address - Phone:772-530-5000
Mailing Address - Fax:772-223-8486
Practice Address - Street 1:931 SE OCEAN BLVD
Practice Address - Street 2:STE A
Practice Address - City:STUART
Practice Address - State:FL
Practice Address - Zip Code:34994-2425
Practice Address - Country:US
Practice Address - Phone:772-288-6300
Practice Address - Fax:772-288-6374
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK4328Medicare ID - Type Unspecified