Healthcare Provider Details

I. General information

NPI: 1730178229
Provider Name (Legal Business Name): 18TH MEDCOM, DCSFHP-OHS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121ST GENERAL HOSPITAL. BOX#567
APO AP
96205
KR

IV. Provider business mailing address

121ST GENERAL HOSPITAL. BOX#567
APO AP
96205
KR

V. Phone/Fax

Practice location:
  • Phone: 315-736-6692
  • Fax: 315-736-3028
Mailing address:
  • Phone: 315-736-6692
  • Fax: 315-736-3028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number StateIL

VIII. Authorized Official

Name: MR. MISO HUH
Title or Position: OCCUPATIONAL HEALTH NURSE
Credential: RN
Phone: 315-736-6692