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General NPI Number Information
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NPI Number | 1255519740
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Entity Type | Organization
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Legal Business Name | LYSTER ARMY HEALTH CLINIC
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Dates
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Enumeration Date | 02/06/2008
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Last Update Date | 02/06/2008
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Provider Practice Location Address
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Address Line | ANDREWS AVE BUILDING 301
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City | FT RUCKER
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State | AL
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Zip | 36362
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Country | US
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Telephone | 334-255-7033
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Fax |
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Provider Business Mailing Address
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Address Line | ANDREWS AVENUE BLDG 301
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City | FT RUCKER
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State | AL
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Zip | 36362
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Country | US
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Telephone | 334-255-7033
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Fax |
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Authorized Official
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Title or Position | RN
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Name | CAROLYN ANN BOOZER
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Credential |
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Telephone | 334-255-7033
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1102X
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Taxonomy Name | Military Outpatient Operational (Transportable) Component Clinic/Center
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License Number | 1-044039
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License Number State | AL
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