Provider Demographics
NPI:1134294705
Name:FORT BELVOIR COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:FORT BELVOIR COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:E
Authorized Official - Last Name:OH
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:301-496-8092
Mailing Address - Street 1:9300 DEWITT LOOP
Mailing Address - Street 2:ATTN TPCP
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5901
Mailing Address - Country:US
Mailing Address - Phone:571-231-2856
Mailing Address - Fax:
Practice Address - Street 1:9300 DEWITT LOOP
Practice Address - Street 2:
Practice Address - City:FORT BELVOIR
Practice Address - State:VA
Practice Address - Zip Code:22060
Practice Address - Country:US
Practice Address - Phone:571-231-3224
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-21
Last Update Date:2018-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
183500000X, 261QM1100X, 261QM1101X, 2865M2000X, 332000000X, 341800000X
MD179301835X0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
No1835X0200XPharmacy Service ProvidersPharmacistOncologyGroup - Multi-Specialty
No261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
No261QM1101XAmbulatory Health Care FacilitiesClinic/CenterMilitary and U.S. Coast Guard Ambulatory Procedure
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No341800000XTransportation ServicesMilitary/U.S. Coast Guard TransportGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
VAVAD000Medicare UPIN