Provider Demographics
NPI:1003209735
Name:US ARMY
Entity Type:Organization
Organization Name:US ARMY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BATTALION SURGEON
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:
Authorized Official - Last Name:HESSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:912-435-0011
Mailing Address - Street 1:1790 WILLIAM H WILSON AVE
Mailing Address - Street 2:
Mailing Address - City:FORT STEWART
Mailing Address - State:GA
Mailing Address - Zip Code:31314-3100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1790 WILLIAM H WILSON AVE
Practice Address - Street 2:
Practice Address - City:FORT STEWART
Practice Address - State:GA
Practice Address - Zip Code:31314-3100
Practice Address - Country:US
Practice Address - Phone:912-435-0011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-04
Last Update Date:2015-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12890146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, ParamedicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
M8074351OtherNREMT REG #
NR00426616OtherNREMT CANDIDATE ID