1508031220 NPI number — DR. MEGHAN ROCHELLE MONT D.O.

Table of content: DR. MEGHAN ROCHELLE MONT D.O. (NPI 1508031220)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508031220 NPI number — DR. MEGHAN ROCHELLE MONT D.O.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONT
Provider First Name:
MEGHAN
Provider Middle Name:
ROCHELLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
D.O.
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:
1508031220
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/06/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 399
Provider Second Line Business Mailing Address:
214 S 4TH STREET
Provider Business Mailing Address City Name:
KREMMLING
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80459-0399
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-724-3442
Provider Business Mailing Address Fax Number:
970-724-9606

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
214 SOUTH 4TH STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KREMMLING
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80459-0399
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-887-1216
Provider Business Practice Location Address Fax Number:
970-887-1820
Provider Enumeration Date:
04/23/2008

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: 207Q00000X , with the licence number:  48559 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 48559 . This is a "STATE MEDICAL LICENSE" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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