| Organization Name: | KENNER ARMY HEALTH CLINIC |
| NPI Number: | 1043591175 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CARLOS RODRIGUEZ-ROSADO (NCOIC PAD) |
| Mailing Address: | 700 24th St Bldg 3219 Ncxo Tmc Fort Lee |
| State: | VA US |
| Postal Code: | 238011716 |
| Phone Number: | 8047349000 |
| Fax Number: | |
| NPI Enumeration Date: | 09/02/2011 |
| NPI Last Update Date: | 01/30/2014 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1100X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| 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 |