1699987438 NPI number — U.S. MARINE CORPS FORCES COMMAND

Table of content: (NPI 1699987438)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699987438 NPI number — U.S. MARINE CORPS FORCES COMMAND

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
U.S. MARINE CORPS FORCES COMMAND
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:
1699987438
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:
HEALTH SERVICES SUPPORT 1468 INGRAM ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORFOLK
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23551-2596
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
757-836-1685
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
CLR-27, 2D MLG, PSC BOX 20125
Provider Second Line Business Practice Location Address:
BLDG 308, HOLCOLM BLVD.
Provider Business Practice Location Address City Name:
CAMP LEJEUNE
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28542
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
910-450-6672
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
MOELLER
Authorized Official First Name:
MICHAEL
Authorized Official Middle Name:
SCOTT
Authorized Official Title or Position:
GROUP SURGEON, 2D MARINE LOG GRP
Authorized Official Telephone Number:
910-450-6672

Provider Taxonomy Codes

  • Taxonomy code: 261QM1100X , with the licence number:  MD-6125 , 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)





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