Enrique C Montana, M.D.

Primary specialty

Surgery PhysicianTaxonomy code 208600000X

License

MD00047673 Issued in WA

Practice address

1119 Highland Ave Ste 6
Clarkston, WA 99403-2836

Phone

(509) 254-2722

Fax

(509) 769-2022

NPI assigned

Nov 22, 2005

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Lima Memorial Joint Operating Company

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)
• Livingston Healthcare

  • Critical Access Hospital
  • Livingston, MT
  • NPI 1245222306
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1132617600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1383004800000",
    "number": "1295718385",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1221 HIGHLAND AVE",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032829",
            "telephone_number": "509-758-5511",
            "fax_number": "509-769-2022"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1119 HIGHLAND AVE STE 6",
            "city": "CLARKSTON",
            "state": "WA",
            "postal_code": "994032836",
            "telephone_number": "509-254-2722",
            "fax_number": "509-769-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MONTANA",
        "first_name": "ENRIQUE",
        "middle_name": "C",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2005-11-22",
        "last_updated": "2013-10-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "ID",
            "license": "M- 10599",
            "primary": false
        },
        {
            "code": "208600000X",
            "taxonomy_group": "",
            "desc": "Surgery",
            "state": "WA",
            "license": "MD00047673",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENCE",
            "identifier": "MD00047673",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TRAVLERS RAILROAD",
            "identifier": "020000619",
            "state": "ID"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0433632",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "AETNA",
            "identifier": "4466435",
            "state": "ID"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "ANTHEM",
            "identifier": "000000027381",
            "state": "ID"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Zachary Robert Meyers, DDS
• Michael Minick, MD
• Karen M Monroe, OTR/L
• Rachel Montgomery
• Kayleigh Moyle
• Joseph Farayi Moyosviyi
• Mary L Muench, CRNA
• Gayle Y Muir, MS

• Surgery Physician in Clarkston, WA
• Providers in Clarkston, WA by specialty
• Surgery Physician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 29, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.