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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1891899274	OTHER		PARENT FACILITY IRELAND ACH NPI

General Provider Information

NPI Number	:	1700092509
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	:	1679 S 10TH AVE
Second Line	:	MCCOY OHC
City	:	FORT MCCOY
State	:	WI
Zip	:	54656-5114
Country	:	US
Telephone Number	:	608-388-3209
Fax Number	:

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	BARBARA HORNBACK
Credential	:
Telephone Number	:	502-624-9870

Provider Enumeration Date	:	05/16/2007
Last Update Date	:	04/01/2015

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Directions to “IRELAND ARMY COMMUNITY HOSPITAL ” Practice Location

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