MEDICARE: US NAVY

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	261QM1102X	Military Outpatient Operational (Transportable) Component Clinic/Center

General Provider Information

NPI Number	:	1982862728
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US NAVY

Provider Business Mailing Address
First Line	:	PSC 819 BOX 1835
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09645-1801
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	PSC 819 BOX 1835
Second Line	:
City	:	FPO
State	:	AE
Zip	:	09645-1801
Country	:	US
Telephone Number	:	34956824465
Fax Number	:

Authorized Official
Title or Position	:	INDEPENDENT DUTY CORPSMAN
Name	:	CHRISTOPHER LEE CRUMPLER
Credential	:
Telephone Number	:	34956824465

Provider Enumeration Date	:	05/29/2008
Last Update Date	:	05/29/2008

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Directions to “US NAVY ” Practice Location

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