Healthcare Provider Details

I. General information

NPI: 1982862728
Provider Name (Legal Business Name): US NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/29/2008
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 819 BOX 1835
FPO AE
09645-1801
US

IV. Provider business mailing address

PSC 819 BOX 1835
FPO AE
09645-1801
US

V. Phone/Fax

Practice location:
  • Phone: 34956824465
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1102X
TaxonomyMilitary Outpatient Operational (Transportable) Component Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CHRISTOPHER LEE CRUMPLER
Title or Position: INDEPENDENT DUTY CORPSMAN
Credential:
Phone: 34956824465