Provider Demographics
NPI:1922279850
Name:CENTRAL MONTGOMERY MEDICAL CENTER, LLC
Entity Type:Organization
Organization Name:CENTRAL MONTGOMERY MEDICAL CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MANAGING DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:
Authorized Official - Last Name:WILSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-361-4401
Mailing Address - Street 1:100 MEDICAL CAMPUS DR
Mailing Address - Street 2:MONTGOMERY COUNTY SURGICAL ASSOCIATES
Mailing Address - City:LANSDALE
Mailing Address - State:PA
Mailing Address - Zip Code:19446
Mailing Address - Country:US
Mailing Address - Phone:215-361-4590
Mailing Address - Fax:
Practice Address - Street 1:125 MEDICAL CAMPUS DR SUITE #205
Practice Address - Street 2:MONTGOMERY COUNTY SURGICAL ASSOCIATES
Practice Address - City:LANSDALE
Practice Address - State:PA
Practice Address - Zip Code:19446
Practice Address - Country:US
Practice Address - Phone:215-361-4590
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-19
Last Update Date:2008-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208600000XAllopathic & Osteopathic PhysiciansSurgeryGroup - Single Specialty