MEDICARE: MONTGOMERY COUNTY MH-MR EMERGENCY SERVICE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	341600000X	Ambulance	03261	PA
2	283Q00000X	Psychiatric Hospital	173410	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	1373	OTHER	PA	AETNA
3	48810	OTHER	PA	KEYSTONE MERCY
4	1158	OTHER	PA	BLUE CROSS

General Provider Information

NPI Number	:	1386637734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY COUNTY MH-MR EMERGENCY SERVICE

Provider Business Mailing Address
First Line	:	50 BEECH DR
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-5421
Country	:	US
Telephone Number	:	610-279-6100
Fax Number	:	610-279-0978

Provider Business Practice Location Address
First Line	:	50 BEECH DR
Second Line	:
City	:	NORRISTOWN
State	:	PA
Zip	:	19403-5421
Country	:	US
Telephone Number	:	610-279-6100
Fax Number	:	610-279-0978

Authorized Official
Title or Position	:	ADMINISTRATIVE ASSISTANT
Name	:	DEBORAH SHANLEY
Credential	:
Telephone Number	:	610-279-6100

Provider Enumeration Date	:	08/31/2005
Last Update Date	:	08/12/2010

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