Provider Demographics
NPI:1003985219
Name:549TH HOSPITAL CENTER/BDAACH
Entity Type:Organization
Organization Name:549TH HOSPITAL CENTER/BDAACH
Other - Org Name:549TH HOSPITAL CENTER/BDAACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, UBO
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DEWAYNE
Authorized Official - Last Name:HENDRICKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:315-737-1857
Mailing Address - Street 1:549TH HOSPITAL CENTER/BDAACH
Mailing Address - Street 2:UNIT # 15245
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96271
Mailing Address - Country:US
Mailing Address - Phone:315-737-1857
Mailing Address - Fax:
Practice Address - Street 1:549TH HOSPITAL CENTER/BDAACH
Practice Address - Street 2:UNIT #15245
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96271
Practice Address - Country:US
Practice Address - Phone:315-737-1857
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
8210027OtherNCPDP