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General NPI Number Information
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NPI Number | 1811960149
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Entity Type | Organization
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Legal Business Name | RAYMOND W. BLISS HEALTH CEMTER
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Dates
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Enumeration Date | 02/08/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2240 E. WINROW AVE. MEDDAC
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City | FT. HUACHUCA
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State | AZ
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Zip | 85613
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Country | US
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Telephone | 520-538-1546
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Fax |
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Provider Business Mailing Address
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Address Line | 600 CHANTILLY DR
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City | SIERRA VISTA
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State | AZ
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Zip | 85635-4732
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Country | US
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Telephone | 520-459-6698
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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. GUADALUPE VAN HUSS
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Credential | LPN
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Telephone | 520-538-1546
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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 | LP028575
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License Number State | AZ
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