Provider Demographics
NPI:1952169682
Name:PRIBYL MONTAGUE MEDICAL CORPORATION
Entity Type:Organization
Organization Name:PRIBYL MONTAGUE MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:PRIBYL
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:707-646-4414
Mailing Address - Street 1:1860 PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:94533-3590
Mailing Address - Country:US
Mailing Address - Phone:707-646-4414
Mailing Address - Fax:
Practice Address - Street 1:3434 VILLA LN STE 380
Practice Address - Street 2:
Practice Address - City:NAPA
Practice Address - State:CA
Practice Address - Zip Code:94558-6416
Practice Address - Country:US
Practice Address - Phone:707-646-4414
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty