Provider Demographics
NPI:1275570376
Name:MONTGOMERY REGIONAL HOSPITAL INC
Entity Type:Organization
Organization Name:MONTGOMERY REGIONAL HOSPITAL INC
Other - Org Name:LEWISGALE HOSPITAL MONTGOMERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAASKEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:540-953-5155
Mailing Address - Street 1:3700 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BLACKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24060-7017
Mailing Address - Country:US
Mailing Address - Phone:540-951-1111
Mailing Address - Fax:540-953-5295
Practice Address - Street 1:3700 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BLACKSBURG
Practice Address - State:VA
Practice Address - Zip Code:24060-7017
Practice Address - Country:US
Practice Address - Phone:540-951-1111
Practice Address - Fax:540-953-5295
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-31
Last Update Date:2021-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036964700Medicaid
FL091834200Medicaid
KY1601236Medicaid
VA004901100Medicaid
VA007618OtherWELLPOINT
030206700OtherBLACK LUNG
109351OtherNCPPO
GA000174545XMedicaid
148836900OtherDEPT OF LABOR
223903OtherALLIANCE
WV0168025000Medicaid
VA268565OtherWELLPOINT
490110Medicare Oscar/Certification