Basic Information
| Provider Information | |||||||||
| NPI: | 1245568013 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | US ARMY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 541 N 10TH DR | ||||||||
| Address2: | |||||||||
| City: | SHOW LOW | ||||||||
| State: | AZ | ||||||||
| PostalCode: | 859014568 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9152081875 | ||||||||
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| Practice Location | |||||||||
| Address1: | 600 CAISSON HILL RD | ||||||||
| Address2: | |||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664427037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/06/2009 | ||||||||
| LastUpdateDate: | 12/06/2009 | ||||||||
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| AuthorizedOfficialLastName: | KANE | ||||||||
| AuthorizedOfficialFirstName: | NANCY | ||||||||
| AuthorizedOfficialMiddleName: | NICOLLE | ||||||||
| AuthorizedOfficialTitleorPosition: | CRNA | ||||||||
| AuthorizedOfficialTelephone: | 9152081875 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CRNA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 286500000X | Y | Hospitals | Military Hospital |
No ID Information.