Healthcare Provider Details

I. General information

NPI: 1114133923
Provider Name (Legal Business Name): GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2007
Last Update Date: 04/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4300 GOODFELLOW BLVD GOODFELLOW COMPLEX BLDG 103D
SAINT LOUIS MO
63120-1703
US

IV. Provider business mailing address

4430 MISSOURI AVE BOX 1242
FORT LEONARD WOOD MO
65473-9098
US

V. Phone/Fax

Practice location:
  • Phone: 573-596-0035
  • Fax:
Mailing address:
  • Phone: 573-596-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1100X
TaxonomyMilitary/U.S. Coast Guard Outpatient Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: NANCY LAMBERT
Title or Position: UBO MANAGER
Credential:
Phone: 573-596-0494