Healthcare Provider Details

I. General information

NPI: 1538365036
Provider Name (Legal Business Name): TRIPLER ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2007
Last Update Date: 12/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 660 MCCORNACK ROAD DENTAL CLINIC
SCHOFIELD BARRACKS HI
96857
US

IV. Provider business mailing address

1 JARRETT WHITE RD ATTN PAD MCHK-PAT-T
TRIPLER ARMY MEDICAL CENTER HI
96859-5001
US

V. Phone/Fax

Practice location:
  • Phone: 808-433-8901
  • Fax:
Mailing address:
  • Phone: 808-433-6103
  • 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: HUGH KEEL
Title or Position: PRMC UBO
Credential:
Phone: 808-433-1016