1477058840 NPI number — INTERNATIONAL SOS GOVERNMENT MEDICAL SERVICES, INC.

Table of content: (NPI 1477058840)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477058840 NPI number — INTERNATIONAL SOS GOVERNMENT MEDICAL SERVICES, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
INTERNATIONAL SOS GOVERNMENT MEDICAL SERVICES, INC.
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:
6
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:
1477058840
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/18/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
708 MAIN ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77002-3208
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-320-9092
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
KWAJALEIN HOSPITAL
Provider Second Line Business Practice Location Address:
UNIT 45081
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96555-5801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
805-355-2224
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/28/2018

Additional Information

Authorized Official

Authorized Official Last Name:
HASS
Authorized Official First Name:
ROBERT
Authorized Official Middle Name:
Authorized Official Title or Position:
GENERAL MANAGER
Authorized Official Telephone Number:
202-320-9092

Provider Taxonomy Codes

  • Taxonomy code: 286500000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MHL000002MHL0000 . This is a "TRICARE PROVIDER ENCOUNTER RECORD VALIDATION" identifier . This identifiers is of the category "OTHER".




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