1396743910 NPI number — MONTGOMERY HOSPITAL

Table of content: (NPI 1396743910)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1396743910 NPI number — MONTGOMERY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY HOSPITAL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MONTGOMERY HOSPITAL MEDICAL CENTER
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1396743910
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/17/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1301 POWELL ST
Provider Second Line Business Mailing Address:
P.O. BOX 0992
Provider Business Mailing Address City Name:
NORRISTOWN
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19401-3323
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
610-270-2000
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1301 POWELL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORRISTOWN
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19401-3323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
610-270-2000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/08/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LADELY
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
SENIOR VICE PRESIDENT AND CFO
Authorized Official Telephone Number:
610-270-2067

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  390801 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 08296 . This is a "HEALTH PARTNERS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 30619 . This is a "BLACK LUNG" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 390108/P00914 . This is a "PGBA TRICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001106000 . This is a "BLUE CROSS PRODUCTS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: IY0091 . This is a "HEALTH NET" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 504483 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 100774444-0002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 390108 . This is a "AMERIHEALTH ADMINISTRATOR" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 00758608-04 . This is a "AMERICHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 70002 . This is a "KEYSTONE/MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0001325 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 70002 . This is a "AMERIHEALTH MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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