Provider Demographics
NPI:1033325840
Name:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Other - Org Name:RICHARD G. WILSON CTMC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF, UBO
Authorized Official - Prefix:
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:
Authorized Official - Last Name:LAMBER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:573-596-0494
Mailing Address - Street 1:126 MISSOURI AVE
Mailing Address - Street 2:ATTN MCXP RMD UB BOX 1242
Mailing Address - City:FORT LEONARD WOOD
Mailing Address - State:MO
Mailing Address - Zip Code:65473-8952
Mailing Address - Country:US
Mailing Address - Phone:573-596-0494
Mailing Address - Fax:
Practice Address - Street 1:ALABAMA AVENUE BLDG 885
Practice Address - Street 2:
Practice Address - City:FORT LEONARD WOOD
Practice Address - State:MO
Practice Address - Zip Code:65473-8952
Practice Address - Country:US
Practice Address - Phone:573-596-1906
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GENERAL LEONARD WOOD ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-16
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
2633104OtherPHARMACY NCPDP
AN2598588OtherMEDCO
2633104OtherPHARMACY NCPDP
VAD000Medicare UPIN