1497702591 NPI number — US ARMY HEALTH CLINIC

Table of content: (NPI 1497702591)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497702591 NPI number — US ARMY HEALTH CLINIC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US 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:
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:
1497702591
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5116 KISTER AVE
Provider Second Line Business Mailing Address:
ATTN: MSA OFFICE
Provider Business Mailing Address City Name:
DUGWAY
Provider Business Mailing Address State Name:
UT
Provider Business Mailing Address Postal Code:
84022-1097
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
435-831-3313
Provider Business Mailing Address Fax Number:
435-831-3360

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5116 KISTER AVE
Provider Second Line Business Practice Location Address:
RM #119
Provider Business Practice Location Address City Name:
DUGWAY
Provider Business Practice Location Address State Name:
UT
Provider Business Practice Location Address Postal Code:
84022-1097
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
435-831-3313
Provider Business Practice Location Address Fax Number:
435-831-3360
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
BURLINGAME
Authorized Official First Name:
ELIZABETH
Authorized Official Middle Name:
Authorized Official Title or Position:
UBO MANAGER
Authorized Official Telephone Number:
719-526-7291

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: AN2598588 . This is a "MEDCO" identifier . This identifiers is of the category "OTHER".
  • Identifier: 4609307 . This is a "NCPDP" identifier . This identifiers is of the category "OTHER".




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