MEDICARE: DCSFHP, OHS, 18TH MEDCOM

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	0001131457	VA

General Provider Information

NPI Number	:	1508856212
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DCSFHP, OHS, 18TH MEDCOM

Provider Business Mailing Address
First Line	:	HSC 168TH MED BN, UNIT 15021, BOX 10-B
Second Line	:
City	:	APO
State	:	AP
Zip	:	96218
Country	:	KR
Telephone Number	:	53-470-5567
Fax Number	:

Provider Business Practice Location Address
First Line	:	168TH MED BN UNIT 15021, BOX 10-B
Second Line	:
City	:	APO
State	:	AP
Zip	:	96218
Country	:	US
Telephone Number	:	01182537645567
Fax Number	:

Authorized Official
Title or Position	:	OCCUPATIONAL HEALTH NURSE
Name	:	MRS. KUN AI CHO
Credential	:	RN
Telephone Number	:	53-470-5567

Provider Enumeration Date	:	10/25/2005
Last Update Date	:	07/21/2022

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