Healthcare Provider Details

I. General information

NPI: 1821294729
Provider Name (Legal Business Name): MCDONALD ARMY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2007
Last Update Date: 04/01/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BUILDING 82 INGALS
FORT MONROE VA
23651
US

IV. Provider business mailing address

579 JEFFERSON AVE ATTN UBO
FORT EUSTIS VA
23604-1526
US

V. Phone/Fax

Practice location:
  • Phone: 757-314-7500
  • Fax:
Mailing address:
  • Phone: 757-314-7770
  • 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: DONNA ALBRIGHT
Title or Position: UBO REP
Credential:
Phone: 757-314-7755