Provider Demographics
NPI:1093859076
Name:US COAST GUARD MEDICAL
Entity Type:Organization
Organization Name:US COAST GUARD MEDICAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICE TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:VILLOCH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-372-4100
Mailing Address - Street 1:1220 WINFIELD CT
Mailing Address - Street 2:
Mailing Address - City:KING GEORGE
Mailing Address - State:VA
Mailing Address - Zip Code:22485-6771
Mailing Address - Country:US
Mailing Address - Phone:540-775-7834
Mailing Address - Fax:
Practice Address - Street 1:1220 WINFIELD CT
Practice Address - Street 2:
Practice Address - City:KING GEORGE
Practice Address - State:VA
Practice Address - Zip Code:22485-6771
Practice Address - Country:US
Practice Address - Phone:540-775-7834
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization