Provider Demographics
NPI:1376982413
Name:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Other - Org Name:CAMPB VIRTUAL PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DEPUTY DIRECTOR PHCY OPS CTR
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:210-221-8443
Mailing Address - Street 1:650 JOEL DR BLDG B
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-798-8060
Mailing Address - Fax:270-798-8065
Practice Address - Street 1:650 JOEL DR BLDG B
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-798-8060
Practice Address - Fax:270-798-8065
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy