MEDICARE: BASSETT 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

General Provider Information

NPI Number	:	1730383886
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BASSETT ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	1060 GAFFNEY RD STOP 7420
Second Line	:	ATTN MCUC-PAD-TPC
City	:	FORT WAINWRIGHT
State	:	AK
Zip	:	99703-5007
Country	:	US
Telephone Number	:	907-361-5948
Fax Number	:

Provider Business Practice Location Address
First Line	:	3406 ALDER AVE
Second Line	:	MCDS-DD-TDC
City	:	FT WAINWRIGHT
State	:	AK
Zip	:	99703-5002
Country	:	US
Telephone Number	:	907-361-5172
Fax Number	:

Authorized Official
Title or Position	:	UBO MANAGER
Name	:	TIMOTHY SPENCER
Credential	:
Telephone Number	:	907-361-5948

Provider Enumeration Date	:	06/13/2007
Last Update Date	:	04/08/2015

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