1063642668 NPI number — BRIAN ALLGOOD COMMUNITY HOSPITAL

Table of content: (NPI 1063642668)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063642668 NPI number — BRIAN ALLGOOD COMMUNITY HOSPITAL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BRIAN ALLGOOD 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:
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:
1063642668
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
121 CSH BOX 372
Provider Second Line Business Mailing Address:
UNIT 15244 APO AP
Provider Business Mailing Address City Name:
YONGSAN
Provider Business Mailing Address State Name:
SEOUL
Provider Business Mailing Address Postal Code:
96205
Provider Business Mailing Address Country Code:
KR
Provider Business Mailing Address Telephone Number:
315-736-6693
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
121 COMBAT SUPPORT HOSPITAL
Provider Second Line Business Practice Location Address:
UNIT 15244
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
315-373-3203
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
07/17/2009

Additional Information

Authorized Official

Authorized Official Last Name:
FOSTER
Authorized Official First Name:
ANA
Authorized Official Middle Name:
MARITZA
Authorized Official Title or Position:
PUBLIC HEALTH NURSE
Authorized Official Telephone Number:
210-745-2368

Provider Taxonomy Codes

  • Taxonomy code: 261QC1500X , with the licence number:  489631 , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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