Basic Information
| Provider Information | |||||||||
| NPI: | 1962498733 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTRAL MONTGOMERY MEDICAL CENTER L L C | ||||||||
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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: | 09/27/2005 | ||||||||
| LastUpdateDate: | 05/09/2008 | ||||||||
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| AuthorizedOfficialLastName: | FILTON | ||||||||
| AuthorizedOfficialFirstName: | STEVE | ||||||||
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| AuthorizedOfficialTitleorPosition: | CFO, SENIOR VP | ||||||||
| AuthorizedOfficialTelephone: | 6107683300 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282N00000X | 660101 | PA | Y | Hospitals | General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 01882908 | 05 | PA | MEDICAID |