Provider Demographics
NPI:1386637734
Name:MONTGOMERY COUNTY MH-MR EMERGENCY SERVICE
Entity Type:Organization
Organization Name:MONTGOMERY COUNTY MH-MR EMERGENCY SERVICE
Other - Org Name:MONTGOMERY COUNTY EMERGENCY SERVICE, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:ADMINISTRATIVE ASSISTANT
Authorized Official - Prefix:
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:SHANLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-279-6100
Mailing Address - Street 1:50 BEECH DR
Mailing Address - Street 2:
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19403-5421
Mailing Address - Country:US
Mailing Address - Phone:610-279-6100
Mailing Address - Fax:610-279-0978
Practice Address - Street 1:50 BEECH DR
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19403-5421
Practice Address - Country:US
Practice Address - Phone:610-279-6100
Practice Address - Fax:610-279-0978
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA173410283Q00000X
PA03261341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
No341600000XTransportation ServicesAmbulance
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100756802Medicaid
PA1373OtherAETNA
PA48810OtherKEYSTONE MERCY
PA1158OtherBLUE CROSS
PA48810OtherKEYSTONE MERCY
PA100756802Medicaid
PA692720Medicare ID - Type UnspecifiedPART B - PHYSICIANS