Healthcare Provider Details

I. General information

NPI: 1245568013
Provider Name (Legal Business Name): US ARMY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2009
Last Update Date: 12/06/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 CAISSON HILL RD
FORT RILEY KS
66442-7037
US

IV. Provider business mailing address

541 N 10TH DR
SHOW LOW AZ
85901-4568
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7000
  • Fax:
Mailing address:
  • Phone: 915-208-1875
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: NANCY NICOLLE KANE
Title or Position: CRNA
Credential: CRNA
Phone: 915-208-1875