Provider Demographics
NPI:1285847731
Name:MUNSON ARMY HEALTH CENTER
Entity Type:Organization
Organization Name:MUNSON ARMY HEALTH CENTER
Other - Org Name:TMC #1 (USDB)-FT LEAVENWORTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:C, RM
Authorized Official - Prefix:
Authorized Official - First Name:JIMMIE
Authorized Official - Middle Name:
Authorized Official - Last Name:PERKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:913-684-6726
Mailing Address - Street 1:550 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:FORT LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66027-2332
Mailing Address - Country:US
Mailing Address - Phone:913-684-6048
Mailing Address - Fax:
Practice Address - Street 1:1301 N WAREHOUSE RD
Practice Address - Street 2:
Practice Address - City:FORT LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66027-2364
Practice Address - Country:US
Practice Address - Phone:913-684-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MUNSON ARMY HEALTH CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-08
Last Update Date:2012-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient
Provider Identifiers
StateIdentifier IDID TypeIssuer
OTH000Medicare UPIN
VAD000Medicare UPIN