Basic Information
| Provider Information | |||||||||
| NPI: | 1326465832 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | IRWIN ARMY COMMUNITY HOSPITAL | ||||||||
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| OtherOrganizationName: | 1ST BDE EBH CLINIC-FT. RILEY | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 600 CAISSON HILL RD | ||||||||
| Address2: | ATTN UBO | ||||||||
| City: | FT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664427037 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397724 | ||||||||
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| Practice Location | |||||||||
| Address1: | 7006 NORMANDY AVE | ||||||||
| Address2: | |||||||||
| City: | FT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 66442 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852399711 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/21/2014 | ||||||||
| LastUpdateDate: | 03/21/2014 | ||||||||
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| AuthorizedOfficialLastName: | BUCHMAN | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF, UBO | ||||||||
| AuthorizedOfficialTelephone: | 7852397724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | IRWIN 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 |
ID Information
| ID | Type | State | Issuer | Description | 1649218264 | 01 | PARENT FACILITY NPI 2 | OTHER |