MEDICARE: MONTEREY CONSULTANTS, INC

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	302F00000X	Exclusive Provider Organization

General Provider Information

NPI Number	:	1609329796
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTEREY CONSULTANTS, INC

Provider Business Mailing Address
First Line	:	5335 FAR HILLS AVE
Second Line	:	SUITE 311
City	:	DAYTON
State	:	OH
Zip	:	45429-2350
Country	:	US
Telephone Number	:	937-436-4536
Fax Number	:

Provider Business Practice Location Address
First Line	:	5335 FAR HILLS AVE
Second Line	:	SUITE 311
City	:	DAYTON
State	:	OH
Zip	:	45429-2350
Country	:	US
Telephone Number	:	937-436-4536
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR, PROVIDER RELATIONS
Name	:	MR. ANDREW ALLEN MINNICH
Credential	:
Telephone Number	:	937-436-4536

Provider Enumeration Date	:	07/26/2016
Last Update Date	:	07/26/2016

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