Provider Demographics
NPI:1033517206
Name:UNITED STATES COAST GUARD
Entity Type:Organization
Organization Name:UNITED STATES COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPSMAN
Authorized Official - Prefix:MISS
Authorized Official - First Name:STEPHANIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUBBERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:907-487-5757
Mailing Address - Street 1:BASE KODIAK BUILDING N-46 CAPE SARICHEF
Mailing Address - Street 2:
Mailing Address - City:KODIAK
Mailing Address - State:AK
Mailing Address - Zip Code:99619
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:BASE KODIAK BUILDING N-46
Practice Address - Street 2:
Practice Address - City:KODIAK
Practice Address - State:AK
Practice Address - Zip Code:99619
Practice Address - Country:US
Practice Address - Phone:907-487-5757
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-19
Last Update Date:2014-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient