MEDICARE: UNITED STATES NAVY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	2865M2000X	Military General Acute Care Hospital
2	2865X1600X	Operational (Transportable) Military General Acute Care Hospital
3	286500000X	Military Hospital

General Provider Information

NPI Number	:	1649682154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNITED STATES NAVY

Provider Business Mailing Address
First Line	:	LOGISTICS SUPPORT UNIT ONEMEDIC
Second Line	:	2424 REDOVA RD BLDG 156
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5401
Country	:	US
Telephone Number	:	619-537-3274
Fax Number	:

Provider Business Practice Location Address
First Line	:	LOGISTICS SUPPORT UNIT ONEMEDIC
Second Line	:	2424 REDOVA RD BLDG 156
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-5401
Country	:	US
Telephone Number	:	619-537-3274
Fax Number	:

Authorized Official
Title or Position	:	INDEPENDENT DUTY CORPSMAN
Name	:	ROBERT HOOFFSTETTER
Credential	:	IDC
Telephone Number	:	619-537-3274

Provider Enumeration Date	:	06/02/2014
Last Update Date	:	06/02/2014

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Directions to “UNITED STATES NAVY ” Practice Location

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