Healthcare Provider Details

I. General information

NPI: 1336431519
Provider Name (Legal Business Name): 1 MEB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2011
Last Update Date: 05/06/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8348 ALABAMA AVE
FORT POLK LA
71459-5528
US

IV. Provider business mailing address

8348 ALABAMA AVE
FORT POLK LA
71459-5528
US

V. Phone/Fax

Practice location:
  • Phone: 337-531-6288
  • Fax:
Mailing address:
  • Phone: 337-531-6288
  • 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: MR. MATTHEW KURMAN
Title or Position: 1 LT
Credential: PA-C
Phone: 216-798-8778