1528260874 NPI number — KARON RENE MONTGOMERY M.S., C.G.C.

Table of content: KARON RENE MONTGOMERY M.S., C.G.C. (NPI 1528260874)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528260874 NPI number — KARON RENE MONTGOMERY M.S., C.G.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MONTGOMERY
Provider First Name:
KARON
Provider Middle Name:
RENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.S., C.G.C.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MCMILLAN
Provider Other First Name:
KARON
Provider Other Middle Name:
RENE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.S., C.G.C.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1528260874
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1107 S LEMAY AVE UNIT 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT COLLINS
Provider Business Mailing Address State Name:
CO
Provider Business Mailing Address Postal Code:
80524-3955
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
970-495-7946
Provider Business Mailing Address Fax Number:
970-493-2990

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1107 S LEMAY AVE UNIT 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT COLLINS
Provider Business Practice Location Address State Name:
CO
Provider Business Practice Location Address Postal Code:
80524-3955
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
970-495-7946
Provider Business Practice Location Address Fax Number:
970-493-2990
Provider Enumeration Date:
05/31/2007

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: 170300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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