1689773707 NPI number — US ARMY HEALTH CLINIC

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 1689773707 NPI number — US ARMY HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US ARMY HEALTH CLINIC
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:
6
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:
1689773707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/31/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5116 KISTER AVENUE
Provider Second Line Business Mailing Address:
ATTN MSA OFFICE
Provider Business Mailing Address City Name:
DUGWAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84022
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5116 KISTER AVENUE
Provider Second Line Business Practice Location Address:
ROOM #119
Provider Business Practice Location Address City Name:
DUGWAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84022
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
801-831-2942
Provider Business Practice Location Address Fax Number:
801-831-2552
Provider Enumeration Date:
09/22/2006

Additional Information

Authorized Official

Authorized Official Last Name:
MORALES
Authorized Official First Name:
HECTOR
Authorized Official Middle Name:
Authorized Official Title or Position:
MGR PHRMCY OPERATIONS CNTR
Authorized Official Telephone Number:
210-221-8443

Provider Taxonomy Codes

  • Taxonomy code: 332000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 1497795702 . This is a "PARENT FACILITY NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 005252 . This is a "NCPDP PAYMENT CENTER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 1497702591 . This is a "FACILITY NPI" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4609307 . This is a "OTHER ID NUMBER-COMMERCIAL NUMBER" identifier . This identifiers is of the category "OTHER".




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