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

General Provider Information

NPI Number	:	1912155813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IRELAND ARMY COMMUNITY HOSPITAL

Provider Business Mailing Address
First Line	:	289 IRELAND AVE
Second Line	:
City	:	FORT KNOX
State	:	KY
Zip	:	40121-5111
Country	:	US
Telephone Number	:	502-624-9274
Fax Number	:

Provider Business Practice Location Address
First Line	:	2669 W REGIMENTAL AVE
Second Line	:
City	:	FORT MCCOY
State	:	WI
Zip	:	54656-5229
Country	:	US
Telephone Number	:	502-624-9928
Fax Number	:

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

Provider Enumeration Date	:	09/04/2008
Last Update Date	:	04/11/2014

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