1902103880 NPI number — US ARMY HEALTH CLINIC BAUMHOLDER

Table of content: (NPI 1902103880)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1902103880 NPI number — US ARMY HEALTH CLINIC BAUMHOLDER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US ARMY HEALTH CLINIC BAUMHOLDER
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:
Provider Other Organization Name Type Code:
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:
1902103880
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAHC-BAUMHOLDER
Provider Second Line Business Mailing Address:
UNIT 23809 BOX 52
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09034-0077
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
67-836-6563
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAHC-BAUMHOLDER
Provider Second Line Business Practice Location Address:
UNIT 23809 BOX 52
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09034-0077
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
67-836-6563
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/11/2011

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GRADY
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
D.
Authorized Official Title or Position:
DEPUTY DIRECTOR OF CLINICAL SERVICE
Authorized Official Telephone Number:
314-485-8813

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  3677 , registered in the state of HI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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