1114922341 NPI number — MONTGOMERY GENERAL HOSPITAL, INC.

Table of content: (NPI 1114922341)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114922341 NPI number — MONTGOMERY GENERAL HOSPITAL, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MONTGOMERY GENERAL HOSPITAL, INC.
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:
Provider Other Organization Name Type Code:
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:
1114922341
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/26/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
18101 PRINCE PHILIP DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OLNEY
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20832-1514
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:
301-774-9676

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
18101 PRINCE PHILIP DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OLNEY
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20832-1514
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-774-8649
Provider Business Practice Location Address Fax Number:
301-774-9676
Provider Enumeration Date:
06/15/2005

Additional Information

Authorized Official

Authorized Official Last Name:
HOGARTY
Authorized Official First Name:
JOHN
Authorized Official Middle Name:
Authorized Official Title or Position:
SR. VICE PRESIDENT/ CFO
Authorized Official Telephone Number:
301-774-8649

Provider Taxonomy Codes

  • Taxonomy code: 282N00000X , with the licence number:  15-202 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: O20719200 . This is a "DC MEDICAID" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: 5000047 . This is a "UNITED HEALTH MCO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 234094 . This is a "ALLIANCE PPO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 5000047 . This is a "UNITED HEALTHCARE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 734 . This is a "BCBS NATIONAL ACCOUNTS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: OOO315800 . This is a "MAPS MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 104272 . This is a "KAISER" identifier , issued by the state of ( MH ) . This identifiers is of the category "OTHER".
  • Identifier: 45833 . This is a "AMERICAID MCO" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 235094 . This is a "UFCW/FELRA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 57355901 . This is a "CAREFIRST OF MD" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 9992 . This is a "AETNA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4235094 . This is a "MDIPA" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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