Basic Information
| Provider Information | |||||||||
| NPI: | 1386637734 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONTGOMERY COUNTY MH-MR EMERGENCY SERVICE | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | MONTGOMERY COUNTY EMERGENCY SERVICE, INC. | ||||||||
| OtherOrganizationType: | 4 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 50 BEECH DR | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194035421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102796100 | ||||||||
| FaxNumber: | 6102790978 | ||||||||
| Practice Location | |||||||||
| Address1: | 50 BEECH DR | ||||||||
| Address2: | |||||||||
| City: | NORRISTOWN | ||||||||
| State: | PA | ||||||||
| PostalCode: | 194035421 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6102796100 | ||||||||
| FaxNumber: | 6102790978 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2005 | ||||||||
| LastUpdateDate: | 08/12/2010 | ||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SHANLEY | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATIVE ASSISTANT | ||||||||
| AuthorizedOfficialTelephone: | 6102796100 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 341600000X | 03261 | PA | N | Transportation Services | Ambulance | 283Q00000X | 173410 | PA | Y | Hospitals | Psychiatric Hospital |
ID Information
| ID | Type | State | Issuer | Description | 100756802 | 05 | PA | MEDICAID | 1373 | 01 | PA | AETNA | OTHER | 48810 | 01 | PA | KEYSTONE MERCY | OTHER | 1158 | 01 | PA | BLUE CROSS | OTHER |