Basic Information
| Provider Information | |||||||||
| NPI: | 1831292259 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MUHLENBERG REGIONAL MEDICAL CENTER, INC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | MUHLENBERG HOME CARE PROGRAM | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 PARK AVE & RANDOLPH RD | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070603300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326321571 | ||||||||
| FaxNumber: | 7326321644 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 PARK AVE & RANDOLPH RD | ||||||||
| Address2: | |||||||||
| City: | PLAINFIELD | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 070603300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7326321571 | ||||||||
| FaxNumber: | 7326321644 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/07/2006 | ||||||||
| LastUpdateDate: | 12/14/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | MCGEE | ||||||||
| AuthorizedOfficialFirstName: | JOHN | ||||||||
| AuthorizedOfficialMiddleName: | P | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT AND CEO | ||||||||
| AuthorizedOfficialTelephone: | 7326321501 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X | 72001 | NJ | Y | Agencies | Home Health |
ID Information
| ID | Type | State | Issuer | Description | 0L0554 | 01 | NJ | HEALTHNET | OTHER | 50302 | 01 | NJ | AMERIGROUP | OTHER | 317059 | 01 | NJ | AETNA | OTHER | UN000013700 | 01 | NJ | AMERICHOICE | OTHER | 1091631 | 01 | NJ | HORIZON MERCY OF NJ | OTHER | 317059 | 01 | NJ | NJ HORIZON BCBS | OTHER | 3691004 | 05 | NJ | MEDICAID | 38831 | 01 | NJ | UNIVERSITY HEALTH PLAN | OTHER |