Provider Demographics
NPI:1104021849
Name:BAVARIA MEDDAC
Entity Type:Organization
Organization Name:BAVARIA MEDDAC
Other - Org Name:USADC DE ILLESHEIM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH SYSTEMS SPEC
Authorized Official - Prefix:
Authorized Official - First Name:HELEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SNYDER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:0114963719-464-5471
Mailing Address - Street 1:CMR 402
Mailing Address - Street 2:BLDG 3700 ERMC UBO
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09180
Mailing Address - Country:US
Mailing Address - Phone:0114963719-464-7400
Mailing Address - Fax:
Practice Address - Street 1:CMR 416, BOX A
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09140
Practice Address - Country:US
Practice Address - Phone:011490800-350-3104
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BAVARIA MEDDAC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-20
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient