Healthcare Provider Details

I. General information

NPI: 1588991376
Provider Name (Legal Business Name): IRWIN ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2009
Last Update Date: 01/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7606 PARKER ST TBI CLINIC
FT RILEY KS
66442-4247
US

IV. Provider business mailing address

600 CAISSON HILL RD ATTN UBO
FORT RILEY KS
66442-7037
US

V. Phone/Fax

Practice location:
  • Phone: 785-239-7000
  • Fax:
Mailing address:
  • Phone: 785-239-7724
  • 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 State

VIII. Authorized Official

Name: DEBORAH BUCHMAN
Title or Position: UBO MANAGER
Credential:
Phone: 785-239-7724