| Organization Name: | WILFORD HALL MEDICAL CENTER |
| NPI Number: | 1912968595 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | DARLON B JACKSON (CREDENTIALS MANAGER) |
| Mailing Address: | 2200 Bergquist Dr Suite 1 Attn: Credentials Cmc Lackland A F B |
| State: | TX US |
| Postal Code: | 782369907 |
| Phone Number: | 2102926707 |
| Fax Number: | 2102927964 |
| NPI Enumeration Date: | 03/31/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 286500000X |
| License Number: | MD057195L |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Hospitals |
| Taxonomy Classification: | Military Hospital |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A health care facility operated by the Department of Defense. |