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General NPI Number Information
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NPI Number | 1922199066
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Entity Type | Organization
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Legal Business Name | AHC MCDONALD-EUSTIS
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Dates
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Enumeration Date | 09/27/2006
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Last Update Date | 05/22/2025
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Provider Practice Location Address
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Address Line | 579 JEFFERSON AVE
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City | FORT EUSTIS
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State | VA
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Zip | 23604
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Country | US
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Telephone | 757-314-7500
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Fax |
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Provider Business Mailing Address
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Address Line | 579 JEFFERSON AVE ATTN UBO
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City | FORT EUSTIS
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State | VA
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Zip | 23604
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Country | US
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Telephone | 757-314-7770
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Fax |
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Authorized Official
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Title or Position | UBO MANAGER
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Name | NA'KEESHA DE'BOSE
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Credential |
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Telephone | 757-314-7500
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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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