Provider Demographics
NPI:1265619233
Name:KIM R. MONTEE, M.D., P.C.
Entity type:Organization
Organization Name:KIM R. MONTEE, M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KIM
Authorized Official - Middle Name:RAY
Authorized Official - Last Name:MONTEE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-963-4139
Mailing Address - Street 1:710 SUNSET DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:LA GRANDE
Mailing Address - State:OR
Mailing Address - Zip Code:97850-1200
Mailing Address - Country:US
Mailing Address - Phone:541-963-4139
Mailing Address - Fax:541-963-4412
Practice Address - Street 1:710 SUNSET DR
Practice Address - Street 2:SUITE C
Practice Address - City:LA GRANDE
Practice Address - State:OR
Practice Address - Zip Code:97850-1200
Practice Address - Country:US
Practice Address - Phone:541-963-4139
Practice Address - Fax:541-963-4412
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21272207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR288079Medicaid
OR288079Medicaid
ORH26168Medicare UPIN