1245312792 NPI number — HOHENFELS ARMY HEALTH CLINIC

Table of content: (NPI 1245312792)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1245312792 NPI number — HOHENFELS ARMY HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOHENFELS 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:
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:
1245312792
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:
CMR 414 BOX 1878
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09173
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
01149497949454
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
9 CITADEL ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PIEDMONT
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
864-299-1223
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/20/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ADAMS
Authorized Official First Name:
LATONYA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
EFMP / DIABETIC COORDINATOR/ NURSE
Authorized Official Telephone Number:
-466-4583

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X , with the licence number:  23-34115-122 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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