Healthcare Provider Details

I. General information

NPI: 1497702591
Provider Name (Legal Business Name): US ARMY HEALTH CLINIC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 11/17/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5116 KISTER AVE RM #119
DUGWAY UT
84022-1097
US

IV. Provider business mailing address

5116 KISTER AVE ATTN: MSA OFFICE
DUGWAY UT
84022-1097
US

V. Phone/Fax

Practice location:
  • Phone: 435-831-3313
  • Fax: 435-831-3360
Mailing address:
  • Phone: 435-831-3313
  • Fax: 435-831-3360

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: ELIZABETH BURLINGAME
Title or Position: UBO MANAGER
Credential:
Phone: 719-526-7291