Provider Demographics
NPI:1114922341
Name:MONTGOMERY GENERAL HOSPITAL, INC.
Entity Type:Organization
Organization Name:MONTGOMERY GENERAL HOSPITAL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SR. VICE PRESIDENT/ CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HOGARTY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-774-8649
Mailing Address - Street 1:18101 PRINCE PHILIP DR
Mailing Address - Street 2:
Mailing Address - City:OLNEY
Mailing Address - State:MD
Mailing Address - Zip Code:20832-1514
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:301-774-9676
Practice Address - Street 1:18101 PRINCE PHILIP DR
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1514
Practice Address - Country:US
Practice Address - Phone:301-774-8649
Practice Address - Fax:301-774-9676
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-15
Last Update Date:2007-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15-202282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DCO20719200OtherDC MEDICAID
MD5000047OtherUNITED HEALTH MCO
MD234094OtherALLIANCE PPO
MD5000047OtherUNITED HEALTHCARE
MD734OtherBCBS NATIONAL ACCOUNTS
MDOOO315800OtherMAPS MD
MH104272OtherKAISER
MD45833OtherAMERICAID MCO
MD235094OtherUFCW/FELRA
MD57355901OtherCAREFIRST OF MD
MD9992OtherAETNA
MD4235094OtherMDIPA
MD210018Medicare PIN