Provider Demographics
NPI:1114089588
Name:UNITED STATES COAST GUARD
Entity Type:Organization
Organization Name:UNITED STATES COAST GUARD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HEALTH SERVICES TECHNICIAN
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:LEIGH
Authorized Official - Last Name:SIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-483-8596
Mailing Address - Street 1:1807 WOODGATE ARCH
Mailing Address - Street 2:
Mailing Address - City:CHESAPEAKE
Mailing Address - State:VA
Mailing Address - Zip Code:23320-7805
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4000 COAST GUARD BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23703-2135
Practice Address - Country:US
Practice Address - Phone:757-483-5896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient