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General NPI Number Information
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NPI Number | 1356330641
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Entity Type | Organization
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Legal Business Name | KENNER ARMY HEALTH CLINIC
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Dates
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Enumeration Date | 10/19/2005
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Last Update Date | 08/12/2008
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Provider Practice Location Address
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Address Line | 700 24TH ST
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City | FORT LEE
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State | VA
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Zip | 23801-1716
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Country | US
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Telephone | 804-734-9434
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Fax |
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Provider Business Mailing Address
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Address Line | 23000 WEATHERFRONT LN
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City | DINWIDDIE
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State | VA
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Zip | 23841-2352
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Country | US
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Telephone | 804-469-9157
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Fax |
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Authorized Official
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Title or Position | PI/RM COORDINATOR
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Name | MS. KAREN INGE PHILLIPS
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Credential |
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Telephone | 804-734-9434
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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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