Healthcare Provider Details

I. General information

NPI: 1225095789
Provider Name (Legal Business Name): LANDSTUHL REGIONAL MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

CMR 402 BOX 323
APO AE LANDSTUHL
09180
DE

IV. Provider business mailing address

CMR 402 BOX 323
APO AE LANDSTUHL
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 011496371867002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number0001174855
License Number StateVA

VIII. Authorized Official

Name: TIMOTHY RICHARD WHOOLERY
Title or Position: PUBLIC HEALTH NURSE
Credential: R.N.
Phone: 011496371867002