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

General Provider Information

NPI Number	:	1851596233
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	:	5979 DESERT STORM AVE
Second Line	:	BUILDING 5979
City	:	FORT CAMPBELL
State	:	KY
Zip	:	42223-5584
Country	:	US
Telephone Number	:	270-956-0350
Fax Number	:

Authorized Official
Title or Position	:	C, PAD
Name	:	LIZA J O'NEAL
Credential	:
Telephone Number	:	270-798-8491

Provider Enumeration Date	:	06/18/2007
Last Update Date	:	01/03/2013

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