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1316948656

NPI Code Detail

MEDICARE: MICHAEL T MONTAGUE PAC

MEDICARE: MICHAEL T MONTAGUE PAC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	1208	OK

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	37-1803	OTHER	OK	MEDICARE
5	37-1832	OTHER	OK	MEDICARE
6	37-1834	OTHER	OK	MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
4	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316948656
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL T MONTAGUE PAC

Provider Business Mailing Address
First Line	:	1334 N LANSING AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-5907
Country	:	US
Telephone Number	:	918-587-2171
Fax Number	:	918-295-6155

Provider Business Practice Location Address
First Line	:	1334 N LANSING AVE
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74106-5907
Country	:	US
Telephone Number	:	918-587-2171
Fax Number	:	918-295-6155

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/09/2005
Last Update Date	:	06/19/2008

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Directions to “ MICHAEL T MONTAGUE PAC” Practice Location

Language	Start Address	Practice Location

These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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