Healthcare Provider Details

I. General information

NPI: 1396986220
Provider Name (Legal Business Name): BLANCHFIELD ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2009
Last Update Date: 03/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 2524 22ND STREET
FORT CAMPBELL KY
42223
US

IV. Provider business mailing address

650 JOEL DR
FORT CAMPBELL KY
42223-5318
US

V. Phone/Fax

Practice location:
  • Phone: 270-412-5114
  • Fax: 270-412-5168
Mailing address:
  • Phone: 270-412-5122
  • Fax: 270-412-5168

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MRS. MARQUITA NICOLE SINGLETON
Title or Position: MEDICAL ASSISTANT
Credential: A.S.
Phone: 270-412-5169