Provider Demographics
NPI:1194824458
Name:REYNOLDS ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:REYNOLDS ARMY COMMUNITY HOSPITAL
Other - Org Name:SILL MAIN OP 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:210-536-6650
Mailing Address - Street 1:3009 N WILSON RD ATTN MCUA-PAD-PF
Mailing Address - Street 2:4300 THOMAS ST BLDG 4300
Mailing Address - City:FT SILL
Mailing Address - State:OK
Mailing Address - Zip Code:73503-9042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:REYNOLDS COMM HOSP DEPT OF PHCY
Practice Address - Street 2:4300 THOMAS ST BLDG 4300
Practice Address - City:FT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503
Practice Address - Country:US
Practice Address - Phone:580-458-2300
Practice Address - Fax:580-458-2445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK34540332000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2076246OtherPK
1487752960OtherPARENT FACILITY NPI
3722166OtherOTHER ID NUMBER-COMMERCIAL NUMBER