1881774438 NPI number — BETH C MONTIGUE MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881774438 NPI number — BETH C MONTIGUE MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

MONTIGUE

Provider First Name:

BETH

Provider Middle Name:

C

Provider Name Prefix Text:

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

F

Provider Other Organization Name:

Provider Other Organization Name Type Code:

Provider Other Last Name:

Provider Other First Name:

Provider Other Middle Name:

Provider Other Name Prefix Text:

Provider Other Name Suffix Text:

Provider Other Credential Text:

Provider Other Last Name Type Code:

NPI Number:

1881774438

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

04/18/2016

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

PO BOX 99371

Provider Second Line Business Mailing Address:

Provider Business Mailing Address City Name:

FORT WORTH

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

76199-0371

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

682-885-1855

Provider Business Mailing Address Fax Number:

682-885-7347

Provider First Line Business Practice Location Address:

4001 LONG PRAIRIE RD

Provider Second Line Business Practice Location Address:

STE 140

Provider Business Practice Location Address City Name:

FLOWER MOUND

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

75028-1525

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

972-691-2388

Provider Business Practice Location Address Fax Number:

972-691-2766

Provider Enumeration Date:

10/17/2006

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 208000000X , with the licence number:  K7347 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 036860702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 1750369203 . This is a "GRP NPI NUMBER" identifier . This identifiers is of the category "OTHER".
• Identifier: 140442827 , issued by the state of ( UT ) . This identifiers is of the category "MEDICAID".
• Identifier: 1894758 . This is a "UHC PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 3138743 . This is a "CIGNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 5943758 . This is a "AETNA PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: MONB167468 . This is a "CCHIP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 00U87Z . This is a "BCBSTX GRP PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 8K4010 . This is a "BCBSTX IND PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 140442867 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 214966 . This is a "FIRSTHEALTH PIN" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".