Healthcare Provider Details

I. General information

NPI: 1598083461
Provider Name (Legal Business Name): DEPARTMENT OF THE ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

US ARMY MEDICAL DEPARTMENT ACTIVITY-KOREA UNIT 15244
APO AP
96205-5244
US

IV. Provider business mailing address

US ARMY MEDICAL DEPARTMENT ACTIVITY-KOREA UNIT 15244
APO AP
96205-5244
US

V. Phone/Fax

Practice location:
  • Phone: 31-730-4488
  • Fax:
Mailing address:
  • Phone: 31-730-4488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number6
License Number StateMI

VIII. Authorized Official

Name: MRS. JO-ANN ANITA TAALIB
Title or Position: SOCIAL WORKER
Credential: LMSW, ACSW, MAC
Phone: 31-730-4488