1205898871 NPI number — MADIGAN ARMY MEDICAL CENTER

Table of content: (NPI 1205898871)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205898871 NPI number — MADIGAN ARMY MEDICAL CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADIGAN ARMY MEDICAL CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CALIFORNIA MEDICAL DETACHMENT
Provider Other Organization Name Type Code:
5
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1205898871
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/13/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9040 REID ST.
Provider Second Line Business Mailing Address:
ATTN. MCHJ-QCR
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-3278
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-986-2252
Provider Business Mailing Address Fax Number:
253-986-3278

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
437 CABRILLO ST
Provider Second Line Business Practice Location Address:
SUITE AIA -US ARMY HEALTH CLINIC
Provider Business Practice Location Address City Name:
PRESIDO OF MONTEREY
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
93944
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
831-242-7589
Provider Business Practice Location Address Fax Number:
831-242-6620
Provider Enumeration Date:
04/06/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BARNHART
Authorized Official First Name:
PATRICIA
Authorized Official Middle Name:
Authorized Official Title or Position:
CREDENTIALS MANAGER
Authorized Official Telephone Number:
253-968-2252

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  05743 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 04753 . This is a "LISCENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".