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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1417044702	OTHER		PARENT FACILITY BLANCHFIELD ARMY COMMUNITY HOSPITAL NPI 2

General Provider Information

NPI Number	:	1659785053
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BLANCHFIELD ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	650 JOEL DR
Second Line	:	ATTN UBO
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5318
Country	:	US
Telephone Number	:	270-798-8286
Fax Number	:

Provider Business Practice Location Address
First Line	:	BLDG 6747 A SHAU VALLEY ROAD
Second Line	:
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223
Country	:	US
Telephone Number	:	270-798-8967
Fax Number	:

Authorized Official
Title or Position	:	ACTING UBO MANAGER
Name	:	CHAD HALE
Credential	:
Telephone Number	:	270-798-8286

Provider Enumeration Date	:	06/13/2014
Last Update Date	:	06/13/2014

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Directions to “BLANCHFIELD ARMY COMMUNITY HOSPITAL ” Practice Location

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