Provider Demographics
NPI:1912041013
Name:DOCTORS' HOSPITAL MEDICAL CENTER OF MONTCLAIR
Entity Type:Organization
Organization Name:DOCTORS' HOSPITAL MEDICAL CENTER OF MONTCLAIR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:MARSH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:626-457-7938
Mailing Address - Street 1:5000 SAN BERNARDINO ST
Mailing Address - Street 2:
Mailing Address - City:MONTCLAIR
Mailing Address - State:CA
Mailing Address - Zip Code:91763-2326
Mailing Address - Country:US
Mailing Address - Phone:626-457-7938
Mailing Address - Fax:626-457-7908
Practice Address - Street 1:5000 SAN BERNARDINO ST
Practice Address - Street 2:
Practice Address - City:MONTCLAIR
Practice Address - State:CA
Practice Address - Zip Code:91763-2326
Practice Address - Country:US
Practice Address - Phone:626-457-7938
Practice Address - Fax:626-457-7908
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA282N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes282N00000XHospitalsGeneral Acute Care Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAHSC30584IMedicaid
CAHSP40584IMedicaid
CAZZZA3613ZOtherBLUE SHIELD OF CA
CA050584Medicare ID - Type UnspecifiedMEDICARE