Provider Demographics
NPI:1770710709
Name:MONTAGE MEDICAL GROUP
Entity type:Organization
Organization Name:MONTAGE MEDICAL GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:K
Authorized Official - Last Name:MCMILLAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:831-649-1000
Mailing Address - Street 1:PO BOX 480
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93902-0480
Mailing Address - Country:US
Mailing Address - Phone:831-649-1000
Mailing Address - Fax:831-649-4966
Practice Address - Street 1:275 THE CROSSROADS BLVD STE A
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:CA
Practice Address - Zip Code:93923-8685
Practice Address - Country:US
Practice Address - Phone:831-658-3639
Practice Address - Fax:831-643-0103
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTAGE HEALTH
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-06-17
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty