MEDICARE: MCDONALD ARMY HEALTH CENTER

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	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

General Provider Information

NPI Number	:	1053517433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MCDONALD ARMY HEALTH CENTER

Provider Business Mailing Address
First Line	:	579 JEFFERSON AVE
Second Line	:	ATTN UBO
City	:	FORT EUSTIS
State	:	VA
Zip	:	23604-1526
Country	:	US
Telephone Number	:	757-314-7770
Fax Number	:

Provider Business Practice Location Address
First Line	:	649 NEW GUINEA RD
Second Line	:
City	:	FORT STORY
State	:	VA
Zip	:	23459-1124
Country	:	US
Telephone Number	:	757-422-7077
Fax Number	:

Authorized Official
Title or Position	:	UBO REP
Name	:	DONNA ALBRIGHT
Credential	:
Telephone Number	:	757-314-7755

Provider Enumeration Date	:	06/22/2007
Last Update Date	:	04/01/2015

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