Healthcare Provider Details

I. General information

NPI: 1558566935
Provider Name (Legal Business Name): BLANCHFIELD ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2007
Last Update Date: 01/03/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DR USADC
FORT CAMPBELL KY
42223-5318
US

IV. Provider business mailing address

650 JOEL DR ATTN UBO
FORT CAMPBELL KY
42223-5318
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8240
  • Fax:
Mailing address:
  • Phone: 270-798-8286
  • 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: LIZA J O'NEAL
Title or Position: C, PAD
Credential:
Phone: 270-798-8491