MEDICARE: BLANCHFIELD ARMY COMMUNITY HOSPITAL

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	:	1396986220
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLANCHFIELD ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	650 JOEL DR
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-412-5122
Fax Number	:	270-412-5168

Provider Business Practice Location Address
First Line	:	BLDG 2524 22ND STREET
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223
Country	:	US
Telephone Number	:	270-412-5114
Fax Number	:	270-412-5168

Authorized Official
Title or Position	:	MEDICAL ASSISTANT
Name	:	MRS. MARQUITA NICOLE SINGLETON
Credential	:	A.S.
Telephone Number	:	270-412-5169

Provider Enumeration Date	:	03/24/2009
Last Update Date	:	03/24/2009

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