1306051115 NPI number — MADIGAN ARMY MEDICAL CTR

Table of content: (NPI 1306051115)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306051115 NPI number — MADIGAN ARMY MEDICAL CTR

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MADIGAN ARMY MEDICAL CTR
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:
OLD MADIGAN AMC-FT. LEWIS
Provider Other Organization Name Type Code:
3
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:
1306051115
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/13/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9040A JACKSON AVE
Provider Second Line Business Mailing Address:
ATTN: MCHJ-CSA-U
Provider Business Mailing Address City Name:
TACOMA
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98431-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
253-968-6598
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
W HAYS ST BLDG 9931B
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TACOMA
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98431-1100
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-968-4466
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/14/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MADY
Authorized Official First Name:
KAREN
Authorized Official Middle Name:
Authorized Official Title or Position:
TPC MANAGER
Authorized Official Telephone Number:
253-968-6598

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1841390077 . This is a "PARENT FACILITY NPI" identifier . This identifiers is of the category "OTHER".




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