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General NPI Number Information
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NPI Number | 1730178229
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Entity Type | Organization
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Legal Business Name | 18TH MEDCOM, DCSFHP-OHS
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Dates
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Enumeration Date | 10/17/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 121ST GENERAL HOSPITAL. BOX#567
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City | APO
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State | AP
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Zip | 96205
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Country | KR
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Telephone | 315-736-6692
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Fax | 315-736-3028
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Provider Business Mailing Address
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Address Line | 121ST GENERAL HOSPITAL. BOX#567
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City | APO
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State | AP
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Zip | 96205
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Country | KR
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Telephone | 315-736-6692
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Fax | 315-736-3028
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Authorized Official
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Title or Position | OCCUPATIONAL HEALTH NURSE
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Name | MR. MISO HUH
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Credential | RN
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Telephone | 315-736-6692
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 286500000X
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Taxonomy Name | Military Hospital
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License Number |
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License Number State | IL
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