Basic Information
| Provider Information | |||||||||
| NPI: | 1992901243 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MADIGAN ARMY MEDICAL CTR | ||||||||
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| OtherOrganizationName: | USADC FT. LEWIS 3 | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 9040A JACKSON AVE | ||||||||
| Address2: | ATTN: MCHJ-CSA-U | ||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539686598 | ||||||||
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| Practice Location | |||||||||
| Address1: | 9040A FITZSIMMOND DR | ||||||||
| Address2: | |||||||||
| City: | TACOMA | ||||||||
| State: | WA | ||||||||
| PostalCode: | 984310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2539673416 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/25/2007 | ||||||||
| LastUpdateDate: | 04/13/2015 | ||||||||
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| AuthorizedOfficialLastName: | MADY | ||||||||
| AuthorizedOfficialFirstName: | KAREN | ||||||||
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| AuthorizedOfficialTitleorPosition: | TPC MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2539686598 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | MADIGAN ARMY MEDICAL CTR | ||||||||
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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 |
No ID Information.