1417287368 NPI number — 121ST GENERAL HOSPITAL(BRAIN ALLGOOD ARMY COMMUNITY HOSPITAL)

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 1417287368 NPI number — 121ST GENERAL HOSPITAL(BRAIN ALLGOOD ARMY COMMUNITY HOSPITAL)

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
121ST GENERAL HOSPITAL(BRAIN ALLGOOD 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:
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:
1417287368
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/28/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DODDS-K SAHS
Provider Second Line Business Mailing Address:
UNIT 15549 BOX 59
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96205-5549
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
82279173275
Provider Business Mailing Address Fax Number:
82279176034

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
UNIT 15549 BOX 59
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96205-5549
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
82279173275
Provider Business Practice Location Address Fax Number:
82279176034
Provider Enumeration Date:
12/28/2009

Additional Information

Authorized Official

Authorized Official Last Name:
LUKE-WALTON
Authorized Official First Name:
DORENE
Authorized Official Middle Name:
DENISE
Authorized Official Title or Position:
PHARMACIST/PYXIS ADMINISTRATOR
Authorized Official Telephone Number:
82279173275

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  0202202906 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2865M2000X , with the licence number: 0202202906 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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