Healthcare Provider Details

I. General information

NPI: 1366518433
Provider Name (Legal Business Name): AHC MUNSON-LEAVENWORTH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 05/21/2025
Certification Date: 05/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MUNSON ARMY HEALTH CENTER 550 POPE AVENUE
FORT LEAVENWORTH KS
66027
US

IV. Provider business mailing address

MUNSON ARMY HEALTH CENTER 550 POPE AVENUE
FORT LEAVENWORTH KS
66027
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6000
  • Fax:
Mailing address:
  • Phone: 913-684-6048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1101X
TaxonomyMilitary and U.S. Coast Guard Ambulatory Procedure Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TONNESHA JEFFERSON
Title or Position: UBO MANAGER
Credential:
Phone: 913-684-6048