1508062779 NPI number — MCDONALD ARMY HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508062779 NPI number — MCDONALD ARMY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MCDONALD ARMY HEALTH 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:
USADC TIGNOR-LANGLEY-EUSTIS
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:
1508062779
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/01/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
579 JEFFERSON AVE
Provider Second Line Business Mailing Address:
ATTN UBO
Provider Business Mailing Address City Name:
FORT EUSTIS
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23604-1526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-314-7770
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
BUILDING 669 MONROE AVENUE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT EUSTIS
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23604
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
757-878-3434
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
ALBRIGHT
Authorized Official First Name:
DONNA
Authorized Official Middle Name:
Authorized Official Title or Position:
UBO REP
Authorized Official Telephone Number:
757-314-7755

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)