Healthcare Provider Details

I. General information

NPI: 1992107627
Provider Name (Legal Business Name): MUNSON ARMY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2014
Last Update Date: 09/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE BLDG 343, ROOM 1A146
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

550 POPE AVE BLDG 343, ROOM 1A146
FORT LEAVENWORTH KS
66027-2332
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6054
  • Fax:
Mailing address:
  • Phone: 913-684-6054
  • 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 StateNULL

VIII. Authorized Official

Name: DR. APARNA BARBARA RAIZADA
Title or Position: CHIEF, PHARMACY SERVICES
Credential: PHARM.D.
Phone: 913-684-6054