Healthcare Provider Details

I. General information

NPI: 1912298274
Provider Name (Legal Business Name): MADIGAN ARMY MEDICAL CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2011
Last Update Date: 04/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MADIGAN ARMY MEDICAL CTR 9040 FITZSIMMONS DR
TACOMA WA
98431-0001
US

IV. Provider business mailing address

MADIGAN ARMY MEDICAL CTR 9040 FITZSIMMONS DR
TACOMA WA
98431-0001
US

V. Phone/Fax

Practice location:
  • Phone: 805-444-5788
  • Fax:
Mailing address:
  • Phone: 805-444-5788
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code286500000X
TaxonomyMilitary Hospital
License Number
License Number State

VIII. Authorized Official

Name: MR. JEROME PENNER III
Title or Position: HOSPITAL COMMANDER
Credential:
Phone: 253-968-1110