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General NPI Number Information
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NPI Number | 1093859076
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Entity Type | Organization
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Legal Business Name | US COAST GUARD MEDICAL
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Dates
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Enumeration Date | 02/16/2007
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1220 WINFIELD CT
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City | KING GEORGE
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State | VA
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Zip | 22485-6771
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Country | US
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Telephone | 540-775-7834
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Fax |
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Provider Business Mailing Address
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Address Line | 1220 WINFIELD CT
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City | KING GEORGE
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State | VA
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Zip | 22485-6771
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Country | US
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Telephone | 540-775-7834
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Fax |
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Authorized Official
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Title or Position | HEALTH SERVICE TECHNICIAN
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Name | VIKKI DENISE VILLOCH
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Credential |
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Telephone | 202-372-4100
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number |
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License Number State |
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