1417063488 NPI number — US ARMY

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 1417063488 NPI number — US ARMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US ARMY
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:
BAMBERG HEALTH CLINIC
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:
1417063488
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
USAMEDDAC WUERZBURG
Provider Second Line Business Mailing Address:
ATTN: CREDENTIALS OFFICE, UNIT 26610
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09244
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
011499318043616
Provider Business Mailing Address Fax Number:
011499318043241

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USAMEDDAC WUERZBURG
Provider Second Line Business Practice Location Address:
BAMBERG HEALTH CLINIC, UNIT 27528
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09139
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
011499513008619
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
PREHN
Authorized Official First Name:
VICTORIA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
PUBLIC HEALTH
Authorized Official Telephone Number:
011499513008619

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  48890 , registered in the state of WV ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 48890 . This is a "REGISTERED NURSE" identifier , issued by the state of ( WV ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com