Healthcare Provider Details

I. General information

NPI: 1912313222
Provider Name (Legal Business Name): IRELAND ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2014
Last Update Date: 08/19/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 110 RODMAN AVE.
ROCK ISLAND ARSENAL IL
61299-7240
US

IV. Provider business mailing address

IRELAND ARMY COMMUNITY HOSPITAL TREASURERS OFFICE 289 IRELAND AVE
FORT KNOX KY
40121-5111
US

V. Phone/Fax

Practice location:
  • Phone: 309-782-0550
  • Fax: 309-782-0553
Mailing address:
  • Phone: 309-782-0550
  • Fax: 309-782-0553

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332000000X
TaxonomyMilitary/U.S. Coast Guard Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HECTOR MORALES
Title or Position: CHIEF DHA PASS
Credential:
Phone: 210-536-6650