MEDICARE: IRWIN 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	261QM1100X	Military/U.S. Coast Guard Outpatient Clinic/Center

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1649218264	OTHER		PARENT NPI 2

General Provider Information

NPI Number	:	1588991376
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRWIN ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	600 CAISSON HILL RD
Second Line	:	ATTN UBO
City	:	FORT RILEY
State	:	KS
Zip	:	66442-7037
Country	:	US
Telephone Number	:	785-239-7724
Fax Number	:

Provider Business Practice Location Address
First Line	:	7606 PARKER ST
Second Line	:	TBI CLINIC
City	:	FT RILEY
State	:	KS
Zip	:	66442-4247
Country	:	US
Telephone Number	:	785-239-7000
Fax Number	:

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	DEBORAH BUCHMAN
Credential	:
Telephone Number	:	785-239-7724

Provider Enumeration Date	:	11/16/2009
Last Update Date	:	01/07/2013

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