Basic Information
| Provider Information | |||||||||
| NPI: | 1275631202 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL MONTGOMERY MEDICAL CENTER LLC | ||||||||
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| OtherOrganizationName: | CENTRAL MONTGOMERY PROFESSIONAL SERVICES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 100 MEDICAL CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | LANSDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194461259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153682100 | ||||||||
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| Practice Location | |||||||||
| Address1: | 100 MEDICAL CAMPUS DR | ||||||||
| Address2: | |||||||||
| City: | LANSDALE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194461259 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153682100 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/21/2006 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | E | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO/MANAGING DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2153614400 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RC0000X | 660101 | PA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Internal Medicine | Cardiovascular Disease | 207ZP0102X | 660101 | PA | X | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pathology | Anatomic Pathology & Clinical Pathology |
No ID Information.