Healthcare Provider Details

I. General information

NPI: 1346455391
Provider Name (Legal Business Name): WEED ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/12/2007
Last Update Date: 04/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 C ST BLDG 990
YUMA AZ
85365-9498
US

IV. Provider business mailing address

4TH STREET BLDG 166 RM 109
FORT IRWIN CA
92310-5109
US

V. Phone/Fax

Practice location:
  • Phone: 928-328-2666
  • Fax:
Mailing address:
  • Phone: 760-380-5213
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DERRECK SUMMERS
Title or Position: C, PAD
Credential:
Phone: 760-380-3392