Provider Demographics
NPI:1134125016
Name:VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY, INC.
Entity Type:Organization
Organization Name:VIRTUA - MEMORIAL HOSPITAL BURLINGTON COUNTY, INC.
Other - Org Name:VIRTUA MOUNT HOLLY HOSPITAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP FOR FINANCE
Authorized Official - Prefix:MR
Authorized Official - First Name:GERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:LOWE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:856-355-0604
Mailing Address - Street 1:175 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT HOLLY
Mailing Address - State:NJ
Mailing Address - Zip Code:08060-2038
Mailing Address - Country:US
Mailing Address - Phone:856-355-2000
Mailing Address - Fax:856-355-2011
Practice Address - Street 1:175 MADISON AVE
Practice Address - Street 2:
Practice Address - City:MOUNT HOLLY
Practice Address - State:NJ
Practice Address - Zip Code:08060-2038
Practice Address - Country:US
Practice Address - Phone:609-267-0700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ10301282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4138902Medicaid
NJ0053406OtherHEALTHSTART
310057Medicare Oscar/Certification