Healthcare Provider Details

I. General information

NPI: 1801039417
Provider Name (Legal Business Name): IRELAND ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2009
Last Update Date: 06/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

EVANS ROAD BLDG 2
CAMP ATTERBURY IN
46124-5000
US

IV. Provider business mailing address

289 IRELAND AVE ATTN: TREASURER OFFICE
FORT KNOX KY
40121-5111
US

V. Phone/Fax

Practice location:
  • Phone: 812-526-1499
  • Fax: 812-526-1178
Mailing address:
  • Phone: 502-624-9274
  • Fax:

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