Provider Demographics
NPI:1346279445
Name:FHPG, LLC
Entity Type:Organization
Organization Name:FHPG, LLC
Other - Org Name:MONTGOMERY MEMORIAL HOSPITAL PROFESSIONAL SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MRS
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DEJACO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-715-1913
Mailing Address - Street 1:PO BOX 8500
Mailing Address - Street 2:
Mailing Address - City:PINEHURST
Mailing Address - State:NC
Mailing Address - Zip Code:28374-8500
Mailing Address - Country:US
Mailing Address - Phone:910-715-1010
Mailing Address - Fax:910-715-1926
Practice Address - Street 1:520 ALLEN ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:NC
Practice Address - Zip Code:27371-2802
Practice Address - Country:US
Practice Address - Phone:910-571-5000
Practice Address - Fax:910-715-1926
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-01
Last Update Date:2015-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014CMMedicaid
NCBCBSOtherBCBS OF NC GROUP NUMBER
NC89014CMMedicaid