Healthcare Provider Details

I. General information

NPI: 1518912823
Provider Name (Legal Business Name): NH GUANTANAMO BAY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2006
Last Update Date: 06/12/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USNH COMMANDING OFFICE PATIENT ACCOUNTS
FPO AE
09589
US

IV. Provider business mailing address

PSC 810
FPO AE
09589
US

V. Phone/Fax

Practice location:
  • Phone: 011539972230
  • Fax: 01153992252
Mailing address:
  • Phone: 757-458-2998
  • Fax: 01153992252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. BRISA PAGAN
Title or Position: UBO MANAGER
Credential:
Phone: 757-458-2998