Healthcare Provider Details

I. General information

NPI: 1245312792
Provider Name (Legal Business Name): HOHENFELS ARMY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 CITADEL ST
PIEDMONT SC
29673
US

IV. Provider business mailing address

CMR 414 BOX 1878
APO AE
09173
DE

V. Phone/Fax

Practice location:
  • Phone: 864-299-1223
  • Fax:
Mailing address:
  • Phone: 01149497949454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number23-34115-122
License Number StateKS

VIII. Authorized Official

Name: MRS. LATONYA R. ADAMS
Title or Position: EFMP / DIABETIC COORDINATOR/ NURSE
Credential: LPN
Phone: -466-4583