Provider Demographics
NPI:1801122767
Name:MONTEITH D. AUSTIN, M.D., INC
Entity type:Organization
Organization Name:MONTEITH D. AUSTIN, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MONTEITH
Authorized Official - Middle Name:D
Authorized Official - Last Name:AUSTIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-584-2759
Mailing Address - Street 1:PO BOX 126
Mailing Address - Street 2:
Mailing Address - City:KINGSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:93631-0126
Mailing Address - Country:US
Mailing Address - Phone:559-875-6900
Mailing Address - Fax:559-875-6011
Practice Address - Street 1:470 GREENFIELD AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-3576
Practice Address - Country:US
Practice Address - Phone:559-584-2759
Practice Address - Fax:559-584-2811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-28
Last Update Date:2012-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA98715208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
0A987150Medicare PIN