Healthcare Provider Details

I. General information

NPI: 1285759712
Provider Name (Legal Business Name): USCG RALPH NIX MEDICAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/21/2007
Last Update Date: 11/14/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

USCG HQ COMDT (CG-1122) 2100 SECOND STREET SOUTH WEST
WASHINGTON DC
20593-0001
US

IV. Provider business mailing address

USCG HQ COMDT (CG-1122) 2100 SECOND STREET SOUTH WEST
WASHINGTON DC
20593-0001
US

V. Phone/Fax

Practice location:
  • Phone: 202-475-5181
  • Fax: 202-475-5909
Mailing address:
  • Phone: 202-475-5181
  • Fax: 202-475-5909

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: BRANDELLE MARIE DELPH
Title or Position: HEALTH SERVICES TECHNICIAN
Credential: EMT-B
Phone: 707-765-7702