Healthcare Provider Details

I. General information

NPI: 1578872545
Provider Name (Legal Business Name): GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

126 MISSOURI AVE
FORT LEONARD WOOD MO
65473-8952
US

IV. Provider business mailing address

126 MISSOURI AVE
FORT LEONARD WOOD MO
65473-8952
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-4542
  • Fax:
Mailing address:
  • Phone:
  • 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. DANIEL JOSEPH MURRAY
Title or Position: AUDIOLOGY ASSISTANT
Credential:
Phone: 573-596-4542