1568857357 NPI number — UNITED STATES ARMY

Table of content: (NPI 1568857357)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1568857357 NPI number — UNITED STATES ARMY

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
UNITED STATES ARMY
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:
1568857357
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/30/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
91-1030 KAILEOLEA DR
Provider Second Line Business Mailing Address:
E3
Provider Business Mailing Address City Name:
EWA BEACH
Provider Business Mailing Address State Name:
HI
Provider Business Mailing Address Postal Code:
96706-6051
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
806-778-3897
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1 JARRETT WHITE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TRIPLER ARMY MEDICAL CENTER
Provider Business Practice Location Address State Name:
HI
Provider Business Practice Location Address Postal Code:
96859-5001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
808-433-6060
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/30/2015

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BASS
Authorized Official First Name:
JEFFREY
Authorized Official Middle Name:
I
Authorized Official Title or Position:
RESIDENCY DIRECTOR OF TRAINING
Authorized Official Telephone Number:
808-433-6340

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X , with the licence number:  563 , registered in the state of WY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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