Basic Information
| Provider Information | |||||||||
| NPI: | 1205031770 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | KELLER ARMY COMMUNITY HOSPITAL | ||||||||
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| OtherOrganizationName: | USADC FT MONMOUTH | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 900 WASHINGTON RD | ||||||||
| Address2: | ATTN MCUD-RMD-UBO | ||||||||
| City: | WEST POINT | ||||||||
| State: | NY | ||||||||
| PostalCode: | 109961197 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459388239 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1075 STEPHENSON AVE | ||||||||
| Address2: | USADC | ||||||||
| City: | FORT MONMOUTH | ||||||||
| State: | NJ | ||||||||
| PostalCode: | 077031518 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8459388239 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2007 | ||||||||
| LastUpdateDate: | 04/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | TUFFY | ||||||||
| AuthorizedOfficialFirstName: | KENNETH | ||||||||
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| AuthorizedOfficialTitleorPosition: | UBO MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 8459388239 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | KELLER ARMY COMMUNITY HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1100X | Y | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
No ID Information.