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General NPI Number Information
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NPI Number | 1306049895
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Entity Type | Organization
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Legal Business Name | RAYMOND W. BLISS ARMY HEALTH CENTER
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Dates
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Enumeration Date | 06/11/2007
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Last Update Date | 11/17/2015
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Provider Practice Location Address
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Address Line | 45005 ARIZONA STREET
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City | FORT HUACHUCA
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State | AZ
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Zip | 85613
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Country | US
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Telephone | 520-533-1479
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 E WINROW AVE ATTN MCXJ-RMD-MSAO
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City | FORT HUACHUCA
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State | AZ
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Zip | 85613-7079
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Country | US
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Telephone | 520-533-9685
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Fax |
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Authorized Official
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Title or Position | UBO MANAGER
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Name | FAYE LIVINGSTON
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Credential |
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Telephone | 520-533-9685
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1100X
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Taxonomy Name | Military/U.S. Coast Guard Outpatient Clinic/Center
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License Number |
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License Number State |
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