1760687214 NPI number — GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL

Table of content: (NPI 1760687214)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760687214 NPI number — GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
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. LEONARD WOOD ROLL
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:
1760687214
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/22/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
126 MISSOURI AVE
Provider Second Line Business Mailing Address:
ATTN MCXP RMD UB BOX 1242
Provider Business Mailing Address City Name:
FORT LEONARD WOOD
Provider Business Mailing Address State Name:
MO
Provider Business Mailing Address Postal Code:
65473-8952
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
573-596-0494
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1724 NEBRASKA AVE
Provider Second Line Business Practice Location Address:
BUILDING 1608
Provider Business Practice Location Address City Name:
FORT LEONARD WOOD
Provider Business Practice Location Address State Name:
MO
Provider Business Practice Location Address Postal Code:
65473-8939
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
573-596-0364
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/15/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LAMBER
Authorized Official First Name:
NANCY
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIEF, UBO
Authorized Official Telephone Number:
573-596-0494

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)





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