Healthcare Provider Details

I. General information

NPI: 1235345182
Provider Name (Legal Business Name): BAVARIA MEDDAC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 02/12/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 27535
APO AE
09139
US

IV. Provider business mailing address

CMR 402 BLD 3700
APO AE
09180
US

V. Phone/Fax

Practice location:
  • Phone: 0114908003503104
  • Fax:
Mailing address:
  • Phone: 01149637194647400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: HELEN SNYDER
Title or Position: HEALTH SYSTEMS SPEC
Credential:
Phone: 01149637194645471