Basic Information
| Provider Information | |||||||||
| NPI: | 1649218264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | IRWIN ARMY COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 650 HUEBNER RD | ||||||||
| Address2: | ATTN: UNIFORM BUSINESS OFFICE | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664424030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397000 | ||||||||
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| Practice Location | |||||||||
| Address1: | 650 HUEBNER RD | ||||||||
| Address2: | ATTN: UNIFORM BUSINESS OFFICE | ||||||||
| City: | FORT RILEY | ||||||||
| State: | KS | ||||||||
| PostalCode: | 664424030 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7852397000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/04/2006 | ||||||||
| LastUpdateDate: | 05/17/2022 | ||||||||
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| AuthorizedOfficialLastName: | BUCHMAN | ||||||||
| AuthorizedOfficialFirstName: | DEBORAH | ||||||||
| AuthorizedOfficialMiddleName: | DENISE | ||||||||
| AuthorizedOfficialTitleorPosition: | UBO MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7852397724 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 05/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1100X | N | Ambulatory Health Care Facilities | Clinic/Center | Military/U.S. Coast Guard Outpatient | 261QM1101X | N | Ambulatory Health Care Facilities | Clinic/Center | Military and U.S. Coast Guard Ambulatory Procedure | 332000000X | N | Suppliers | Military/U.S. Coast Guard Pharmacy | 341800000X | N | Transportation Services | Military/U.S. Coast Guard Transport | 2865M2000X | Y | Hospitals | Military Hospital | Military General Acute Care Hospital |
ID Information
| ID | Type | State | Issuer | Description | 111376 | 01 | KS | BLUE SHIELD | OTHER | 514 | 01 | KS | BLUE CROSS | OTHER | AN2598588 | 01 | KS | MEDCO PRESCRIBER ID | OTHER |