Basic Information
Provider Information
NPI: 1750777264
EntityType: 2
ReplacementNPI:  
OrganizationName: IRWIN ARMY COMMUNITY HOSPITAL
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName: CBMH FLINT HILLS-RILEY
OtherOrganizationType: 3
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 600 CAISSON HILL RD
Address2: ATTN UBO
City: FORT RILEY
State: KS
PostalCode: 664427037
CountryCode: US
TelephoneNumber: 7852397724
FaxNumber:  
Practice Location
Address1: 623 SOUTHWIND DRIVE
Address2:  
City: JUNCTION CITY
State: KS
PostalCode: 66441
CountryCode: US
TelephoneNumber: 7852397000
FaxNumber:  
Other Information
ProviderEnumerationDate: 04/10/2015
LastUpdateDate: 04/10/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: BUCHMAN
AuthorizedOfficialFirstName: DEBORAH
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition: UBO MANAGER
AuthorizedOfficialTelephone: 7852397724
IsSoleProprietor:  
IsOrganizationSubpart: Y
ParentOrganizationLBN: IRWIN ARMY COMMUNITY HOSPITAL
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
261QM1100X  Y Ambulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient

No ID Information.


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