1174563605 NPI number — KELLIE A RICE-MONTEIRO DO

Table of content: KELLIE A RICE-MONTEIRO DO (NPI 1174563605)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174563605 NPI number — KELLIE A RICE-MONTEIRO DO

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
RICE-MONTEIRO
Provider First Name:
KELLIE
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
DO
Provider Gender Code:
F

Provider's Other Name Information

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 Information

NPI Number:
1174563605
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/30/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4515 SETON CENTER PKWY
Provider Second Line Business Mailing Address:
SUITE 215
Provider Business Mailing Address City Name:
AUSTIN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78759-5290
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
512-231-5506
Provider Business Mailing Address Fax Number:
512-406-6216

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 E WHITESTONE BLVD
Provider Second Line Business Practice Location Address:
BLDG C
Provider Business Practice Location Address City Name:
CEDAR PARK
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78613-5028
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
512-259-3467
Provider Business Practice Location Address Fax Number:
512-406-7303
Provider Enumeration Date:
06/06/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 208000000X , with the licence number:  157546 , registered in the state of MA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208000000X , with the licence number: M7569 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 192181901 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 192181904 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 192181902 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 192181903 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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