MEDICARE: ILLESHEIM HEALTH CLINIC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0005X	Ambulatory Family Planning Facility	671825	CA

General Provider Information

NPI Number	:	1043538994
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ILLESHEIM HEALTH CLINIC

Provider Business Mailing Address
First Line	:	CMR 416 BOX C
Second Line	:
City	:	APO
State	:	AE
Zip	:	09140-9997
Country	:	US
Telephone Number	:	314-467-5112
Fax Number	:

Provider Business Practice Location Address
First Line	:	CMR 416 BOX C
Second Line	:
City	:	APO
State	:	AE
Zip	:	09140-9997
Country	:	US
Telephone Number	:	314-467-5112
Fax Number	:

Authorized Official
Title or Position	:	REGISTERED NURSE
Name	:	MS. SARA K SILVA
Credential	:	BSN
Telephone Number	:	314-467-5119

Provider Enumeration Date	:	05/17/2010
Last Update Date	:	05/17/2010

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Directions to “ILLESHEIM HEALTH CLINIC ” Practice Location

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