Organization Name: | BMA HARIO SASEBO |
NPI Number: | 1023201886 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | GWENDOLYN D STARKS (CLAIMS ASSISTANT) |
Mailing Address: | Psc 475 Box 1 Code 081c Fpo |
State: | AP US |
Postal Code: | 96351 |
Phone Number: | 01181468168574 |
Fax Number: | |
NPI Enumeration Date: | 08/23/2007 |
NPI Last Update Date: | 04/20/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QC1500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Community Health |
Taxonomy Definition: |