Healthcare Provider Details

I. General information

NPI: 1275747149
Provider Name (Legal Business Name): KELLER ARMY COMMUNITY HOSPITAL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2007
Last Update Date: 12/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5631 BALTIMORE ST
FORT DIX NJ
08640-5440
US

IV. Provider business mailing address

900 WASHINGTON RD ATTN MCUD-RMD-UBO
WEST POINT NY
10996-1109
US

V. Phone/Fax

Practice location:
  • Phone: 845-938-4034
  • Fax:
Mailing address:
  • Phone: 845-938-8239
  • 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: KENNETH TUFFY
Title or Position: UBO MANAGER
Credential:
Phone: 845-938-8239