Healthcare Provider Details

I. General information

NPI: 1417063488
Provider Name (Legal Business Name): US ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAMEDDAC WUERZBURG BAMBERG HEALTH CLINIC, UNIT 27528
APO AE
09139
DE

IV. Provider business mailing address

USAMEDDAC WUERZBURG ATTN: CREDENTIALS OFFICE, UNIT 26610
APO AE
09244
DE

V. Phone/Fax

Practice location:
  • Phone: 011499513008619
  • Fax:
Mailing address:
  • Phone: 011499318043616
  • Fax: 011499318043241

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number48890
License Number StateWV

VIII. Authorized Official

Name: VICTORIA JEAN PREHN
Title or Position: PUBLIC HEALTH
Credential: MAJ, AN, MSHS
Phone: 011499513008619