Provider Demographics
NPI:1336283381
Name:HMEDDAC
Entity Type:Organization
Organization Name:HMEDDAC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:REGISTERED NURSE
Authorized Official - Prefix:MS
Authorized Official - First Name:CLUNIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:314-328-6709
Mailing Address - Street 1:USAG HESSEN, CMR 470, BOX 4429
Mailing Address - Street 2:
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09165
Mailing Address - Country:DE
Mailing Address - Phone:314-328-6709
Mailing Address - Fax:328-6608
Practice Address - Street 1:USAG HESSEN, CMR 470, BOX 4429
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09165
Practice Address - Country:DE
Practice Address - Phone:314-328-6709
Practice Address - Fax:328-6608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI39086261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service