Provider Demographics
NPI:1164104592
Name:MONTGOMERY GENERAL HOSPITAL, INC
Entity Type:Organization
Organization Name:MONTGOMERY GENERAL HOSPITAL, INC
Other - Org Name:MGH OUTPATIENT PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:DONNA
Authorized Official - Middle Name:
Authorized Official - Last Name:RAYNES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:304-442-5151
Mailing Address - Street 1:PO BOX 270
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:WV
Mailing Address - Zip Code:25136-0270
Mailing Address - Country:US
Mailing Address - Phone:304-442-5151
Mailing Address - Fax:304-442-7494
Practice Address - Street 1:401 6TH AVE
Practice Address - Street 2:
Practice Address - City:MONTGOMERY
Practice Address - State:WV
Practice Address - Zip Code:25136-2116
Practice Address - Country:US
Practice Address - Phone:304-442-5151
Practice Address - Fax:304-442-7494
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY GENERAL HOSPITAL, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-08-04
Last Update Date:2023-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy