| Organization Name: | LYSTER ARMY HEALTH CLINIC |
| NPI Number: | 1093029027 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | ROSE GRAYER (LPN) |
| Mailing Address: | Lyster Army Health Clinic Bldg 301 Andrews Avenue Fort Rucker |
| State: | AL US |
| Postal Code: | 363625333 |
| Phone Number: | 3342557894 |
| Fax Number: | 3342557368 |
| NPI Enumeration Date: | 08/02/2010 |
| NPI Last Update Date: | 08/02/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QF0400X |
| License Number: | 220648 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | TX |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Federally Qualified Health Center (FQHC) |
| Taxonomy Definition: | |