Basic Information
| Provider Information | |||||||||
| NPI: | 1942783246 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | BLANCHFIELD ARMY COMMUNITY HOSPITAL | ||||||||
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| Mailing Information | |||||||||
| Address1: | 110 RODMAN AVE | ||||||||
| Address2: | |||||||||
| City: | ROCK ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5026249274 | ||||||||
| FaxNumber: | 3097820553 | ||||||||
| Practice Location | |||||||||
| Address1: | BLDG 110 PHARM USA HEALTH CLINIC | ||||||||
| Address2: | |||||||||
| City: | ROCK ISLAND | ||||||||
| State: | IL | ||||||||
| PostalCode: | 612990001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3097820550 | ||||||||
| FaxNumber: | 3097820553 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/12/2018 | ||||||||
| LastUpdateDate: | 09/12/2018 | ||||||||
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| AuthorizedOfficialLastName: | GONZALEZ | ||||||||
| AuthorizedOfficialFirstName: | ROSEMARY | ||||||||
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| AuthorizedOfficialTitleorPosition: | MTF SUPPORT | ||||||||
| AuthorizedOfficialTelephone: | 2105366096 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | BLANCHFIELD ARMY COMMUNITY HOSPITAL | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332000000X | Y | Suppliers | Military/U.S. Coast Guard Pharmacy |
No ID Information.