Healthcare Provider Details

I. General information

NPI: 1619038957
Provider Name (Legal Business Name): MADIGAN ARMY MEDICAL CENTER.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

BLDG 11582 17TH & C STREET
FT. LEWIS WA
98433-1100
US

IV. Provider business mailing address

7224 RIDGEMONT DR SE
OLYMPIA WA
98513
US

V. Phone/Fax

Practice location:
  • Phone: 253-966-7594
  • Fax:
Mailing address:
  • Phone: 360-459-7280
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1103X
TaxonomyMilitary Ambulatory Procedure Visits Operational (Transportable) Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GAIL REID GALLOWAY
Title or Position: PHYSICIANS ASSISTANT
Credential: PA-C
Phone: 253-967-7594