Healthcare Provider Details

I. General information

NPI: 1578871414
Provider Name (Legal Business Name): BLANCHFIELD ARMY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/14/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

650 JOEL DRIVE
FT CAMPBELL KY
42223
US

IV. Provider business mailing address

2040 COUNTY HOME RD
PARIS TN
38242-8602
US

V. Phone/Fax

Practice location:
  • Phone: 270-798-8400
  • Fax:
Mailing address:
  • Phone: 731-642-6435
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2865M2000X
TaxonomyMilitary General Acute Care Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. ALEC EDWARD ROSS
Title or Position: PHYSICIAN ASSISTANT
Credential:
Phone: 731-336-5189