Healthcare Provider Details

I. General information

NPI: 1902103880
Provider Name (Legal Business Name): US ARMY HEALTH CLINIC BAUMHOLDER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 02/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USAHC-BAUMHOLDER UNIT 23809 BOX 52
APO AE
09034-0077
US

IV. Provider business mailing address

USAHC-BAUMHOLDER UNIT 23809 BOX 52
APO AE
09034-0077
US

V. Phone/Fax

Practice location:
  • Phone: 67-836-6563
  • Fax:
Mailing address:
  • Phone: 67-836-6563
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number3677
License Number StateHI

VIII. Authorized Official

Name: JAMES D. GRADY
Title or Position: DEPUTY DIRECTOR OF CLINICAL SERVICE
Credential:
Phone: 314-485-8813