1801092077 NPI number — MADIGAN ARMY MEDICAL CTR

Table of content: (NPI 1801092077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801092077 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:
USADC FT. LEWIS CDI
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:
1801092077
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:
BUILDING 2140, LIGGETT AVENUE
Provider Second Line Business Practice Location Address:
ROOM 2050
Provider Business Practice Location Address City Name:
FORT LEWIS
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
253-967-5822
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/25/2007

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)