Provider Demographics
NPI:1467683235
Name:MONTAGE MEDICAL
Entity Type:Organization
Organization Name:MONTAGE MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:SALEMI
Authorized Official - Suffix:
Authorized Official - Credentials:RPSGT
Authorized Official - Phone:510-263-3333
Mailing Address - Street 1:985 ATLANTIC AVE
Mailing Address - Street 2:SUITE 260
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-6447
Mailing Address - Country:US
Mailing Address - Phone:510-263-3333
Mailing Address - Fax:
Practice Address - Street 1:985 ATLANTIC AVE
Practice Address - Street 2:SUITE 260
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-6447
Practice Address - Country:US
Practice Address - Phone:510-263-3333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GROVE MEDICAL EQUIPMENT
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-28
Last Update Date:2009-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48140332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies