MEDICARE: IRELAND ARMY COMMUNITY HOSPITAL

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2146682	OTHER		PK

General Provider Information

NPI Number	:	1912313222
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRELAND ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	IRELAND ARMY COMMUNITY HOSPITAL
Second Line	:	TREASURERS OFFICE 289 IRELAND AVE
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5111
Country	:	US
Telephone Number	:	309-782-0550
Fax Number	:	309-782-0553

Provider Business Practice Location Address
First Line	:	BLDG 110 RODMAN AVE.
Second Line	:
City	:	ROCK ISLAND ARSENAL
State	:	IL
Zip	:	61299-7240
Country	:	US
Telephone Number	:	309-782-0550
Fax Number	:	309-782-0553

Authorized Official
Title or Position	:	CHIEF DHA PASS
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-536-6650

Provider Enumeration Date	:	07/08/2014
Last Update Date	:	08/19/2015

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Directions to “IRELAND ARMY COMMUNITY HOSPITAL ” Practice Location

Language	Start Address	Practice Location

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