Provider Demographics
NPI:1164591251
Name:NAVAL HOSPITAL YOKOSUKA
Entity Type:Organization
Organization Name:NAVAL HOSPITAL YOKOSUKA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NAVY MEDICINE UBO PROGRAM MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:CONDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-401-3643
Mailing Address - Street 1:PSC 564 BOX 800 BLDG 263
Mailing Address - Street 2:
Mailing Address - City:FPO
Mailing Address - State:AP
Mailing Address - Zip Code:96387
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:PSC 564
Practice Address - Street 2:
Practice Address - City:FPO
Practice Address - State:AP
Practice Address - Zip Code:96387
Practice Address - Country:US
Practice Address - Phone:210-536-6650
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NAVAL HOSPITAL YOKOSUKA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-06
Last Update Date:2017-12-19
Deactivation Date:2008-06-03
Deactivation Code:
Reactivation Date:2010-07-23
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2114130OtherPK