Healthcare Provider Details

I. General information

NPI: 1306108394
Provider Name (Legal Business Name): LANDSTUHL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2012
Last Update Date: 06/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LANDSTUHL REGIONAL MEDICAL CNETER CMR 402
APO AE
09180-0000
US

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180-0000
US

V. Phone/Fax

Practice location:
  • Phone: 637-186-8590
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License NumberR168308
License Number StateMD

VIII. Authorized Official

Name: MS. MAUREEN DAVIS
Title or Position: CREDENTIALS PROGRAM MANAGER
Credential:
Phone: 637-186-8590