Provider Demographics
NPI:1114026150
Name:RAYMOND W BLISS ARMY HEALTH CENTER
Entity Type:Organization
Organization Name:RAYMOND W BLISS ARMY HEALTH CENTER
Other - Org Name:HUACHUCA MAIN PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6690
Mailing Address - Street 1:RAYMOND W BLISS ARMY HEALTH CENTER
Mailing Address - Street 2:MCXJ-RMD-MSAO 2240 E WINROW AVE
Mailing Address - City:FT HUACHUCA
Mailing Address - State:AZ
Mailing Address - Zip Code:85613-5080
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2 W BLISS ARMY HEALTH CTR
Practice Address - Street 2:BLDG 45001
Practice Address - City:FT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613
Practice Address - Country:US
Practice Address - Phone:520-533-2520
Practice Address - Fax:520-533-0464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2015-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1990527OtherPK
0324272OtherOTHER ID NUMBER-COMMERCIAL NUMBER
005559OtherPAYMENT CENTER ID