Healthcare Provider Details

I. General information

NPI: 1508856212
Provider Name (Legal Business Name): DCSFHP, OHS, 18TH MEDCOM
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2005
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168TH MED BN UNIT 15021, BOX 10-B
APO AP
96218
US

IV. Provider business mailing address

HSC 168TH MED BN, UNIT 15021, BOX 10-B
APO AP
96218
KR

V. Phone/Fax

Practice location:
  • Phone: 01182537645567
  • Fax:
Mailing address:
  • Phone: 53-470-5567
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number0001131457
License Number StateVA

VIII. Authorized Official

Name: MRS. KUN AI CHO
Title or Position: OCCUPATIONAL HEALTH NURSE
Credential: RN
Phone: 53-470-5567