Healthcare Provider Details

I. General information

NPI: 1982046942
Provider Name (Legal Business Name): USA SCHWEINFURT HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LEDWARD BARRACKS BLDG 201 SCHWEINFURT
APO AE
97422
US

IV. Provider business mailing address

UNIT 25850 BOX 7
APO AE
09033-5850
US

V. Phone/Fax

Practice location:
  • Phone: 314-354-6378
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number308918
License Number StateTX

VIII. Authorized Official

Name: CARLA M ESCANUELA-CARDENAS
Title or Position: LPN
Credential:
Phone: 314-354-6378