Healthcare Provider Details

I. General information

NPI: 1053681957
Provider Name (Legal Business Name): LANDSTUHL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/09/2012
Last Update Date: 01/09/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402
APO AE
09180
US

IV. Provider business mailing address

PSC 2 BOX 8509
APO AE
09012-0035
US

V. Phone/Fax

Practice location:
  • Phone: 06371868108
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number30305740
License Number StateNY

VIII. Authorized Official

Name: MS. COLLEEN R SCHAIDLE
Title or Position: RN/ NURSE PRACTITIONER
Credential: RN, NP
Phone: 06371868108