1497036529 NPI number — KENNER ARMY HEALTH CLINIC

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 1497036529 NPI number — KENNER ARMY HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
KENNER 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:
TMC-2 KENNER-FT LEE
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:
1497036529
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/30/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
700 24TH ST
Provider Second Line Business Mailing Address:
ATTN PAD
Provider Business Mailing Address City Name:
FORT LEE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
23801-1716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
804-734-9306
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2601 C AVE
Provider Second Line Business Practice Location Address:
TMC 2 BLD T8204
Provider Business Practice Location Address City Name:
FORT LEE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
23801-1717
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
804-734-9000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/02/2011

Additional Information

Authorized Official

Authorized Official Last Name:
RODRIGUEZ-ROSADO
Authorized Official First Name:
CARLOS
Authorized Official Middle Name:
Authorized Official Title or Position:
NCOIC PAD
Authorized Official Telephone Number:
804-734-9299

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)

  • Identifier: 1891854014 . This is a "PARENT FACILITY NPI" identifier . This identifiers is of the category "OTHER".




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