Healthcare Provider Details

I. General information

NPI: 1538440532
Provider Name (Legal Business Name): LANDSTHUL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/02/2011
Last Update Date: 09/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402
APO AE
09180
US

IV. Provider business mailing address

CMR 467 BOX 5916
APO AE
09096-0060
US

V. Phone/Fax

Practice location:
  • Phone: 496371868590
  • Fax:
Mailing address:
  • Phone:
  • 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. MAUREEN DAVIS
Title or Position: HEALTH SYSTEMS SPECIALIST
Credential:
Phone: 011496371867283