Basic Information
Provider Information | |||||||||
NPI: | 1295930683 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | IRELAND ARMY COMMUNITY HOSPITAL | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | USADC FT. KNOX IRELAND ACH | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 289 IRELAND AVE | ||||||||
Address2: | ATTN: TREASURERS OFFICE | ||||||||
City: | FORT KNOX | ||||||||
State: | KY | ||||||||
PostalCode: | 401215111 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5026249274 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 851 IRELAND AVE | ||||||||
Address2: |   | ||||||||
City: | FORT KNOX | ||||||||
State: | KY | ||||||||
PostalCode: | 401212722 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 5026249670 | ||||||||
FaxNumber: |   | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/18/2007 | ||||||||
LastUpdateDate: | 04/02/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | HORNBACK | ||||||||
AuthorizedOfficialFirstName: | BARBARA | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | UBO MANAGER | ||||||||
AuthorizedOfficialTelephone: | 5026249870 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | Y | ||||||||
ParentOrganizationLBN: | IRELAND ARMY COMMUNITY HOSPITAL | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1100X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient |
ID Information
ID | Type | State | Issuer | Description | 1891899274 | 01 |   | PARENT FACILITY IRELAND ACH NPI | OTHER |