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General NPI Number Information
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NPI Number | 1417044702
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Entity Type | Organization
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Legal Business Name | ACH BLANCHFIELD-FT CAMPBELL
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Dates
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Enumeration Date | 10/06/2006
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Last Update Date | 05/21/2025
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Provider Practice Location Address
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Address Line | 650 JOEL DR
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-798-8286
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Fax | 270-798-8286
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Provider Business Mailing Address
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Address Line | 650 JOEL DR ATTN UBO
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5318
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Country | US
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Telephone | 270-798-8286
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Fax | 270-956-0450
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Authorized Official
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Title or Position | UBO MANAGER
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Name | MS. SHARON L TUCKER
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Credential |
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Telephone | 270-798-8286
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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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Taxonomy #2
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Taxonomy Code | 261QM1101X
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Taxonomy Name | Military and U.S. Coast Guard Ambulatory Procedure Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 332000000X
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Taxonomy Name | Military/U.S. Coast Guard Pharmacy
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 341800000X
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Taxonomy Name | Military/U.S. Coast Guard Transport,
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License Number |
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License Number State |
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Taxonomy #5
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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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