Healthcare Provider Details

I. General information

NPI: 1417030891
Provider Name (Legal Business Name): USAMEDDAC WUERZBURG, UNIT 26610
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

GRAFENWOEHR HEALTH CLINIC BUILDING 475
APO AE
09114
US

IV. Provider business mailing address

CMR 415 BOX 4572
APO AE
09114
US

V. Phone/Fax

Practice location:
  • Phone: 09641838307
  • Fax:
Mailing address:
  • Phone: 09641838307
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MRS. RACHELLE MONIC HUGHES
Title or Position: NURSING ASSISTANT
Credential:
Phone: 09641838307