NPIMap

Organization Active NPI

Montgomery General Hospital, Inc

  • Rural Health Clinic/Center
  • Montgomery, WV
National Provider Identifier
1548890221
Registry record updated Apr 12, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Rural Health Clinic/CenterTaxonomy code 261QR1300X
Legal business name
MONTGOMERY GENERAL HOSPITAL, INC
Practice address
401 6TH Ave
Montgomery, WV 25136-2116
Phone
(304) 442-5151
Fax
(304) 442-7494
NPI assigned
Jan 22, 2020
Organization subpart
Yes
Parent organization
MONTGOMERY GENERAL HOSPITAL, INCAs reported in NPPES

NPPES NPI Registry

Updated by the provider on Apr 12, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Sherri Murray
Title
Cfo
Phone
(304) 442-1246

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatrics PhysicianGroup: 193400000X SINGLE SPECIALTY GROUP 208000000X
Rural Health Clinic/Center 261QR1300X Primary

Addresses

Primary practice location

401 6TH Ave
Montgomery, WV 25136-2116

Mailing address

PO Box 270
Montgomery, WV 25136-0270
Phone (304) 442-5151

Other names 1

  • Montgomery Pediatrics Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in WV

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20200813002829 WV Part A Provider - Rural Health Clinic 6204735269 Practice locations: Montgomery, WV

Other NPIs with the same Medicare PAC ID 4

NPIs whose Medicare enrollments share a PECOS associate control ID (the same enrolled entity).

Rural health clinic certification: CCN 513429

Legal name
MONTGOMERY GENERAL HOSPITAL, INC
Doing business as
MONTGOMERY PEDIATRICS
Certification status
Active
Provider type (POS)
Rural health clinic
Participating since
Dec 29, 2020
Last certification
Dec 29, 2020
Ownership / control type
2B
Organization structure
CorporationNon-profit
Incorporated
Apr 1, 1970 in WV
Enrollment address
401 6TH Ave
Ste 101
Montgomery, WV 25136-2116
Related CCNs
511318

Facilities connected through Provider of Services related, parent or unit certification numbers.

National Provider Directory

National Provider Directory
Tax ID family
Montgomery General Hospital7 organizations share this tax ID, including this one
Part of
Montgomery General Hospital

Other organizations with this tax ID 6

Organizations that report the same tax identification number in the National Provider Directory.

Ownership & related parties

All disclosed owners & managing parties 9

As disclosed on the Medicare enrollment (CMS All Owners files). Individuals include officers, directors and managing employees, who may not hold ownership.

NameRoleSinceShare
Barbara Crist Individual Corporate Director Apr 20, 2006
Vickie Gay Individual Corporate Director Jan 31, 2020
W-2 Managing Employee Jan 31, 2020
Donna Raynes Individual W-2 Managing Employee Jan 31, 2020
Patsy C Tucker Individual Corporate Director Apr 21, 2005
Raleigh L Collins Individual Corporate Director Apr 20, 2006
Montgomery General Hospital, Inc Organization, Montgomery, WV Corporation, Non-profit 5% Or Greater Direct Ownership Interest Apr 1, 2020 100%
Operational/Managerial Control Apr 1, 2020 100%
Other Apr 1, 2020 100%
Joyce Brown Individual Corporate Director Jun 21, 2012
Donald L Smith Individual Corporate Director Apr 19, 2007
Sherri L Murray Individual Corporate Director Jan 31, 2020
W-2 Managing Employee Jan 31, 2020

Owners & managing parties with NPI records 4

Owners and managing parties disclosed on this facility’s Medicare enrollment that are themselves Medicare-enrolled.

Practitioners 39

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 39

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
51D0995690Montgomery Pediatrics401 6TH Avenue Suite 101, Montgomery, WV 25136Certificate of waiverAug 23, 2027

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1579651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1681257600000",
    "number": "1548890221",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 270",
            "city": "MONTGOMERY",
            "state": "WV",
            "postal_code": "251360270",
            "telephone_number": "304-442-5151",
            "fax_number": "304-442-7494"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 6TH AVE",
            "city": "MONTGOMERY",
            "state": "WV",
            "postal_code": "251362116",
            "telephone_number": "304-442-5151",
            "fax_number": "304-442-7494"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MONTGOMERY GENERAL HOSPITAL, INC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "MONTGOMERY GENERAL HOSPITAL, INC",
        "enumeration_date": "2020-01-22",
        "last_updated": "2023-04-12",
        "certification_date": "2023-04-11",
        "status": "A",
        "authorized_official_last_name": "MURRAY",
        "authorized_official_first_name": "SHERRI",
        "authorized_official_title_or_position": "CFO",
        "authorized_official_telephone_number": "304-442-1246"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Pediatrics",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR1300X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rural Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Montgomery Pediatrics",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Montgomery, WV

Sources for this page

Verify at the official NPI Registry.