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General NPI Number Information
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NPI Number | 1396005583
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Entity Type | Organization
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Legal Business Name | DFAS-CL/JFLB
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Dates
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Enumeration Date | 05/21/2012
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Last Update Date | 05/21/2012
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Provider Practice Location Address
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Address Line | 12092 HARMONY CIR
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City | GULFPORT
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State | MS
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Zip | 39503-9524
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Country | US
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Telephone | 850-390-1718
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Fax |
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Provider Business Mailing Address
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Address Line | 12092 HARMONY CIR
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City | GULFPORT
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State | MS
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Zip | 39503-9524
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Country | US
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Telephone | 850-390-1718
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Fax |
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Authorized Official
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Title or Position | INDEPENDENT DUTY CORPSMAN
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Name | DUSTIN BLAKE JONES
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Credential | IDC
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Telephone | 850-390-1718
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2865M2000X
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Taxonomy Name | Military General Acute Care Hospital
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License Number |
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License Number State |
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