1831418904 NPI number — US ARMY MEDICAL DEPARTMENT ACTIVITY KOREA UNIT 15244 APO AP 96205-5244

Table of content: (NPI 1831418904)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831418904 NPI number — US ARMY MEDICAL DEPARTMENT ACTIVITY KOREA UNIT 15244 APO AP 96205-5244

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
US ARMY MEDICAL DEPARTMENT ACTIVITY KOREA UNIT 15244 APO AP 96205-5244
Provider Last Name:
Provider First Name:
Provider Middle Name:
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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:
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Provider Other Credential Text:
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NPI Number Information

NPI Number:
1831418904
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/27/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
HHD USAG CP CASEY
Provider Second Line Business Mailing Address:
UNIT# 15543
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AP
Provider Business Mailing Address Postal Code:
96224-5543
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
706-691-7295
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
HHD USAG CP CASEY
Provider Second Line Business Practice Location Address:
UNIT# 15543
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AP
Provider Business Practice Location Address Postal Code:
96224-5543
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
706-691-7295
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
05/27/2010

Additional Information

Authorized Official

Authorized Official Last Name:
DARDEN
Authorized Official First Name:
KETTELY
Authorized Official Middle Name:
Authorized Official Title or Position:
SOCIAL WORKER
Authorized Official Telephone Number:
31-730-4558

Provider Taxonomy Codes

  • Taxonomy code: 286500000X , with the licence number:  MSW004607 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MSW004607 . This is a "MASTER LEVEL SOCIAL WORKER" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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