MEDICARE: ACH BLANCHFIELD-FT CAMPBELL

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center
2	261QM1101X	Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
3	332000000X	Military/U.S. Coast Guard Pharmacy
4	341800000X	Military/U.S. Coast Guard Transport,
5	2865M2000X	Military General Acute Care Hospital

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	000000250244	OTHER	ANTHEM BLUE CROSS & BLUE
2	1825946	OTHER	NCPDP
3	000000054923	OTHER	ANTHEM BLUE CROSS & BLUE

General Provider Information

NPI Number	:	1417044702
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACH BLANCHFIELD-FT CAMPBELL

Provider Business Mailing Address
First Line	:	650 JOEL DR
Second Line	:	ATTN UBO
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-798-8286
Fax Number	:	270-956-0450

Provider Business Practice Location Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-798-8286
Fax Number	:	270-798-8286

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	MS. SHARON L TUCKER
Credential	:
Telephone Number	:	270-798-8286

Provider Enumeration Date	:	10/06/2006
Last Update Date	:	05/21/2025

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Directions to “ACH BLANCHFIELD-FT CAMPBELL ” Practice Location

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