Montage Health and Wellness Corp

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

Legal business name

MONTAGE HEALTH AND WELLNESS CORP

Practice address

5631 Burke Centre Pkwy Ste C
Burke, VA 22015-2234

Phone

(540) 712-1776

NPI assigned

Oct 8, 2020

Organization subpart

No

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

Authorized official

Name

Patti D Lee

Title

Authorized Official

Phone

(540) 712-1776

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1602115200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635120000000",
    "number": "1306443684",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "17912 WATERFOWL CT",
            "city": "PURCELLVILLE",
            "state": "VA",
            "postal_code": "201324281"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5631 BURKE CENTRE PKWY STE C",
            "city": "BURKE",
            "state": "VA",
            "postal_code": "220152234",
            "telephone_number": "540-712-1776"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTAGE HEALTH AND WELLNESS CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-10-08",
        "last_updated": "2021-10-25",
        "certification_date": "2021-10-25",
        "status": "A",
        "authorized_official_last_name": "LEE",
        "authorized_official_first_name": "PATTI",
        "authorized_official_middle_name": "D",
        "authorized_official_title_or_position": "AUTHORIZED OFFICIAL",
        "authorized_official_telephone_number": "540-712-1776"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Family Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 25, 2021; 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.