Organization Name: | US ARMY |
NPI Number: | 1003051210 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | CHRISTOPHER SCOTT BRACKMAN (PA) |
Mailing Address: | 5587 Lockridge Road Fayetteville |
State: | NC US |
Postal Code: | 28311 |
Phone Number: | 9109886117 |
Fax Number: | |
NPI Enumeration Date: | 12/03/2008 |
NPI Last Update Date: | 12/03/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM1100X |
License Number: | 0010-01314 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | NC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Military/U.S. Coast Guard Outpatient |
Taxonomy Definition: | The Defense Health Program or U.S. Coast Guard funded |