Provider Demographics
NPI:1629076070
Name:MONTGOMERY HOSPITAL
Entity Type:Organization
Organization Name:MONTGOMERY HOSPITAL
Other - Org Name:MONTGOMERY HOSPITAL PSYCHIATRIC UNIT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR VICE PRESIDENT AND CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:W
Authorized Official - Last Name:LADELY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-270-2067
Mailing Address - Street 1:1301 POWELL ST
Mailing Address - Street 2:P.O. BOX 0992
Mailing Address - City:NORRISTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19401-3323
Mailing Address - Country:US
Mailing Address - Phone:610-270-2000
Mailing Address - Fax:
Practice Address - Street 1:1301 POWELL ST
Practice Address - Street 2:
Practice Address - City:NORRISTOWN
Practice Address - State:PA
Practice Address - Zip Code:19401-3323
Practice Address - Country:US
Practice Address - Phone:610-270-2000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MONTGOMERY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2005-07-11
Last Update Date:2010-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA910410273R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes273R00000XHospital UnitsPsychiatric Unit
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100774444-0012Medicaid
PA=========OtherTAX ID
PA=========OtherTAX ID