Provider Demographics
NPI:1124197017
Name:WEED ARMY COMMUNITY HOSPITAL FT IRWIN USA MEDDAC, P.O. BOX 105109,FORT
Entity Type:Organization
Organization Name:WEED ARMY COMMUNITY HOSPITAL FT IRWIN USA MEDDAC, P.O. BOX 105109,FORT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NCOIC LPN WAEDMASTER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:PRIDGEN
Authorized Official - Suffix:
Authorized Official - Credentials:LPN EMT
Authorized Official - Phone:760-380-3144
Mailing Address - Street 1:PO BOX 105109
Mailing Address - Street 2:
Mailing Address - City:FORT IRWIN
Mailing Address - State:CA
Mailing Address - Zip Code:92310-5109
Mailing Address - Country:US
Mailing Address - Phone:760-380-3144
Mailing Address - Fax:
Practice Address - Street 1:4TH ST INNERLOOP
Practice Address - Street 2:USA MEDDAC
Practice Address - City:FORT IRWIN
Practice Address - State:CA
Practice Address - Zip Code:92310-5109
Practice Address - Country:US
Practice Address - Phone:760-380-3144
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-07
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALP00045663286500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital