MEDICARE: 1 MEB

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	286500000X	Military Hospital

General Provider Information

NPI Number	:	1336431519
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	1 MEB

Provider Business Mailing Address
First Line	:	8348 ALABAMA AVE
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5528
Country	:	US
Telephone Number	:	337-531-6288
Fax Number	:

Provider Business Practice Location Address
First Line	:	8348 ALABAMA AVE
Second Line	:
City	:	FORT POLK
State	:	LA
Zip	:	71459-5528
Country	:	US
Telephone Number	:	337-531-6288
Fax Number	:

Authorized Official
Title or Position	:	1 LT
Name	:	MR. MATTHEW KURMAN
Credential	:	PA-C
Telephone Number	:	216-798-8778

Provider Enumeration Date	:	05/06/2011
Last Update Date	:	05/06/2011

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