Healthcare Provider Details

I. General information

NPI: 1871664060
Provider Name (Legal Business Name): US NAVY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/11/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 HULSE RD BLDG 665 SUITE 105 850-452-8051
PENSACOLA FL
32508-1089
US

IV. Provider business mailing address

2792 COTTONWOOD LN
PENSACOLA FL
32514-5917
US

V. Phone/Fax

Practice location:
  • Phone: 850-452-8051
  • Fax:
Mailing address:
  • Phone: 708-370-1616
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number0101240250
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number0101240250
License Number StateVA

VIII. Authorized Official

Name: MRS. ELEANOR REEVES
Title or Position: NOMI CREDENTIALS, PENSACOLA, FL
Credential:
Phone: 850-452-9484