=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336451418
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MONTGOMERY HOSPITAL
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/06/2010
-----------------------------------------------------
Last Update Date | 07/06/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1330 POWELL ST
-----------------------------------------------------
City | NORRISTOWN
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19401-3353
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 610-270-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 251 W DEKALB PIKE APT C306
-----------------------------------------------------
City | KING OF PRUSSIA
-----------------------------------------------------
State | PA
-----------------------------------------------------
Zip | 19406-2491
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 336-455-1204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PROGRAM DIRECTOR
-----------------------------------------------------
Name | DR. HAZEL BLUSTIEN
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 610-270-2000
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 282NR1301X
-----------------------------------------------------
Taxonomy Name | Rural Acute Care Hospital
-----------------------------------------------------
License Number | MT196681
-----------------------------------------------------
License Number State | PA
-----------------------------------------------------