Healthcare Provider Details

I. General information

NPI: 1649682154
Provider Name (Legal Business Name): UNITED STATES NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2014
Last Update Date: 06/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LOGISTICS SUPPORT UNIT ONEMEDIC 2424 REDOVA RD BLDG 156
SAN DIEGO CA
92155-5401
US

IV. Provider business mailing address

LOGISTICS SUPPORT UNIT ONEMEDIC 2424 REDOVA RD BLDG 156
SAN DIEGO CA
92155-5401
US

V. Phone/Fax

Practice location:
  • Phone: 619-537-3274
  • Fax:
Mailing address:
  • Phone: 619-537-3274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2865X1600X
TaxonomyOperational (Transportable) Military General Acute Care Hospital
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: ROBERT HOOFFSTETTER
Title or Position: INDEPENDENT DUTY CORPSMAN
Credential: IDC
Phone: 619-537-3274