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General NPI Number Information
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NPI Number | 1952854648
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Entity Type | Organization
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Legal Business Name | US ARMY HEALTH CLINIC
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Dates
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Enumeration Date | 07/28/2016
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Last Update Date | 07/28/2016
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Provider Practice Location Address
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Address Line | BLDG 2669 WEST REGIMENTAL ROAD
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City | FT MCCOY
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State | WI
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Zip | 54656-5229
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Country | US
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Telephone | 608-388-3025
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Fax | 608-388-4818
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Provider Business Mailing Address
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Address Line | BLDG 2669 WEST REGIMENTAL ROAD
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City | FT MCCOY
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State | WI
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Zip | 54656-5229
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Country | US
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Telephone | 608-388-3025
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Fax | 608-388-4818
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Authorized Official
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Title or Position | NURSE ASSISTANT
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Name | MR. JESSE C KOLLASCH-ROBERTS
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Credential |
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Telephone | 608-388-3025
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | 70101705
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License Number State | WI
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Taxonomy #2
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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 | 343143
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License Number State | WI
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