Provider Demographics
NPI: | 1235103177 |
---|---|
Name: | NAVY MEDICAL BRANCH CLINIC - UK |
Entity Type: | Organization |
Organization Name: | NAVY MEDICAL BRANCH CLINIC - UK |
Other - Org Name: | DEPT OF NAVY |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CLINICAL NURSE |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MICHELLE |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | WOMACK |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | RN |
Authorized Official - Phone: | 044-235-6387 |
Mailing Address - Street 1: | PSC 826 BOX 286 |
Mailing Address - Street 2: | |
Mailing Address - City: | FPO/AE |
Mailing Address - State: | UK |
Mailing Address - Zip Code: | 09420 |
Mailing Address - Country: | GB |
Mailing Address - Phone: | 0149-446-2059 |
Mailing Address - Fax: | |
Practice Address - Street 1: | PSC 821 BOX 22 |
Practice Address - Street 2: | |
Practice Address - City: | FPO/AE |
Practice Address - State: | UK |
Practice Address - Zip Code: | 09421 |
Practice Address - Country: | GB |
Practice Address - Phone: | 0189-561-6387 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2006-02-16 |
Last Update Date: | 2020-08-22 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | R0064683 | 261QP2300X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 261QP2300X | Ambulatory Health Care Facilities | Clinic/Center | Primary Care |