Basic Information
Provider Information
NPI: 1578871414
EntityType: 2
ReplacementNPI:  
OrganizationName: BLANCHFIELD ARMY HOSPITAL
LastName:  
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Credential:  
OtherOrganizationName:  
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Mailing Information
Address1: 2040 COUNTY HOME RD
Address2:  
City: PARIS
State: TN
PostalCode: 382428602
CountryCode: US
TelephoneNumber: 7316426435
FaxNumber:  
Practice Location
Address1: 650 JOEL DRIVE
Address2:  
City: FT CAMPBELL
State: KY
PostalCode: 42223
CountryCode: US
TelephoneNumber: 2707988400
FaxNumber:  
Other Information
ProviderEnumerationDate: 09/14/2010
LastUpdateDate: 09/14/2010
NPIDeactivationReasonCode:  
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ProviderGenderCode:  
AuthorizedOfficialLastName: ROSS
AuthorizedOfficialFirstName: ALEC
AuthorizedOfficialMiddleName: EDWARD
AuthorizedOfficialTitleorPosition: PHYSICIAN ASSISTANT
AuthorizedOfficialTelephone: 7313365189
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix: MR.
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2865M2000X  Y HospitalsMilitary HospitalMilitary General Acute Care Hospital

No ID Information.


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