MEDICARE: US ARMY NURSING CORP

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	275N00000X	Medicare Defined Swing Bed Hospital Unit	533699	NY

General Provider Information

NPI Number	:	1255356416
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US ARMY NURSING CORP

Provider Business Mailing Address
First Line	:	684 IDLEWOOD BLVD
Second Line	:
City	:	BALDWINSVILLE
State	:	NY
Zip	:	13027-3042
Country	:	US
Telephone Number	:	315-638-3444
Fax Number	:

Provider Business Practice Location Address
First Line	:	WEED ARMY COMMUNITY HOSPITAL
Second Line	:
City	:	FORT IRWIN
State	:	CA
Zip	:	92310-5109
Country	:	US
Telephone Number	:	760-386-2800
Fax Number	:

Authorized Official
Title or Position	:	STAFF NURSE
Name	:	MICHAEL A DOOLITTLE
Credential	:	RN
Telephone Number	:	760-386-2800

Provider Enumeration Date	:	07/12/2006
Last Update Date	:	08/22/2020

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