Healthcare Provider Details

I. General information

NPI: 1992984611
Provider Name (Legal Business Name): MAHC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2007
Last Update Date: 10/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

550 POPE AVE MUNSON ARMY HEALTH CENTER (ATTN: MCXN-COD, MS COTTON)
FORT LEAVENWORTH KS
66027-2332
US

IV. Provider business mailing address

550 POPE AVE MUNSON ARMY HEALTH CENTER (ATTN: MCXN-COD, MS COTTON)
FORT LEAVENWORTH KS
66027-2332
US

V. Phone/Fax

Practice location:
  • Phone: 913-684-6562
  • Fax: 913-684-6208
Mailing address:
  • Phone: 913-684-6562
  • Fax: 913-684-6208

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number089969
License Number StateIA

VIII. Authorized Official

Name: MISS VICKI MCLENDON
Title or Position: HEAD NURSE
Credential:
Phone: 913-684-6363