Healthcare Provider Details

I. General information

NPI: 1871703256
Provider Name (Legal Business Name): MADIGAN ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9040 REID STREET MADIGAN ARMY MEDICAL CENTER ATTN MCHJ-EDME
TACOMA WA
98431-0001
US

IV. Provider business mailing address

18304 11TH AVENUE CT E
SPANAWAY WA
98387-1930
US

V. Phone/Fax

Practice location:
  • Phone: 253-968-0354
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number01063325A
License Number StateIN

VIII. Authorized Official

Name: LIONEL RICHARD BROUNTS
Title or Position: SURGEON
Credential: MD
Phone: 253-968-3105