MEDICARE: IRELAND 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	332000000X	Military/U.S. Coast Guard Pharmacy

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	2033242	OTHER		PK

General Provider Information

NPI Number	:	1558460188
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRELAND ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	289 IRELAND AVE
Second Line	:	ATTN: TREASURERS OFFICE
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5111
Country	:	US
Telephone Number	:	502-624-9274
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 127
Second Line	:	GOLD VAULT RD
City	:	FT KNOX
State	:	KY
Zip	:	40121
Country	:	US
Telephone Number	:	502-624-9264
Fax Number	:	502-624-9252

Authorized Official
Title or Position	:	CHIEF DHA PASS
Name	:	HECTOR MORALES
Credential	:
Telephone Number	:	210-536-6650

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	06/24/2015

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Directions to “IRELAND ARMY COMMUNITY HOSPITAL ” Practice Location

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