Provider Demographics
NPI:1104192590
Name:EINSTEIN MEDICAL CENTER MONTGOMERY
Entity Type:Organization
Organization Name:EINSTEIN MEDICAL CENTER MONTGOMERY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSOCIATE VICE PRESIDENT - FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:WALTER
Authorized Official - Middle Name:GORDON
Authorized Official - Last Name:WYATT
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:215-254-3254
Mailing Address - Street 1:559 W GERMANTOWN PIKE
Mailing Address - Street 2:
Mailing Address - City:EAST NORRITON
Mailing Address - State:PA
Mailing Address - Zip Code:19403-4250
Mailing Address - Country:US
Mailing Address - Phone:484-622-1000
Mailing Address - Fax:
Practice Address - Street 1:559 W GERMANTOWN PIKE
Practice Address - Street 2:
Practice Address - City:EAST NORRITON
Practice Address - State:PA
Practice Address - Zip Code:19403-4250
Practice Address - Country:US
Practice Address - Phone:484-622-1000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-29
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA390329Medicare Oscar/Certification