| Organization Name: | LYSTER ARMY HEALTH CLINIC |
| NPI Number: | 1255519740 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | CAROLYN ANN BOOZER (RN) |
| Mailing Address: | Andrews Ave Building 301 Ft Rucker |
| State: | AL US |
| Postal Code: | 36362 |
| Phone Number: | 3342557033 |
| Fax Number: | |
| NPI Enumeration Date: | 02/06/2008 |
| NPI Last Update Date: | 02/06/2008 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 261QM1102X |
| License Number: | 1-044039 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AL |
| Taxonomy Type: | Ambulatory Health Care Facilities |
| Taxonomy Classification: | Clinic/Center |
| Taxonomy Specialization: | Military Outpatient Operational (Transportable) Component |
| Taxonomy Definition: | |