Basic Information
Provider Information | |||||||||
NPI: | 1033140447 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CMMC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | MONTGOMERY MEDICAL EQUIPMENT COMPANY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 2121 POTSHOP LN | ||||||||
Address2: |   | ||||||||
City: | NORRISTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 194033940 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6106306357 | ||||||||
FaxNumber: | 6106308319 | ||||||||
Practice Location | |||||||||
Address1: | 2121 POTSHOP LN | ||||||||
Address2: |   | ||||||||
City: | NORRISTOWN | ||||||||
State: | PA | ||||||||
PostalCode: | 194033940 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 6106306357 | ||||||||
FaxNumber: | 6106308319 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/05/2006 | ||||||||
LastUpdateDate: | 08/22/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | PRICE | ||||||||
AuthorizedOfficialFirstName: | TED | ||||||||
AuthorizedOfficialMiddleName: | H. | ||||||||
AuthorizedOfficialTitleorPosition: | GENERAL MANAGER | ||||||||
AuthorizedOfficialTelephone: | 6106306357 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 46569037 | PA | Y |   | Suppliers | Durable Medical Equipment & Medical Supplies |   |
No ID Information.