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General NPI Number Information
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NPI Number | 1619337995
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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 | 03/01/2016
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Last Update Date | 03/01/2016
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Provider Practice Location Address
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Address Line | 2240 WINROW AVE
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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 | 520-266-3939
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Fax |
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Provider Business Mailing Address
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Address Line | 2240 WINROW AVE
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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 | 520-266-3939
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Fax |
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Authorized Official
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Title or Position | NURSE
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Name | MRS. ALICEA VICTORIA MAAS BARROWS
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Credential | RN
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Telephone | 520-266-3939
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | RN146926
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License Number State | AZ
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