Basic Information
| Provider Information | |||||||||
| NPI: | 1619913647 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MONTGOMERY GENERAL HOSPITAL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 401 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251362116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044425151 | ||||||||
| FaxNumber: | 3044427494 | ||||||||
| Practice Location | |||||||||
| Address1: | 401 6TH AVE | ||||||||
| Address2: | |||||||||
| City: | MONTGOMERY | ||||||||
| State: | WV | ||||||||
| PostalCode: | 251362116 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3044425151 | ||||||||
| FaxNumber: | 3044427494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2006 | ||||||||
| LastUpdateDate: | 02/14/2018 | ||||||||
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| AuthorizedOfficialLastName: | GAY | ||||||||
| AuthorizedOfficialFirstName: | VICKIE | ||||||||
| AuthorizedOfficialMiddleName: | L | ||||||||
| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 3044427400 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC0060X | 72 | WV | Y | Hospitals | General Acute Care Hospital | Critical Access |
ID Information
| ID | Type | State | Issuer | Description | 000303151 | 01 | WV | BLUE CROSS BLUE SHIELD | OTHER | 0001386000 | 05 | WV | MEDICAID | 0001386003 | 05 | WV | MEDICAID | 032083700 | 01 | WV | BLACK LUNG | OTHER | 3810001695 | 05 | WV | MEDICAID | 3810001437 | 05 | WV | MEDICAID |