Provider Demographics
NPI:1265592232
Name:MONTOYA FAMILY PRACTICE, PA
Entity type:Organization
Organization Name:MONTOYA FAMILY PRACTICE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NATALIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTOYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:316-618-0035
Mailing Address - Street 1:8451 E PAWNEE ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67207-5420
Mailing Address - Country:US
Mailing Address - Phone:316-618-0035
Mailing Address - Fax:316-618-0010
Practice Address - Street 1:8451 E PAWNEE ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67207-5420
Practice Address - Country:US
Practice Address - Phone:316-618-0035
Practice Address - Fax:316-618-0010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-00731363A00000X
KS45218363LF0000X
KS0429228207Q00000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS103702OtherMEDICARE PTAN
KS111291OtherBCBS
KS200622560AMedicaid