Provider Demographics
NPI:1386859387
Name:IRELAND ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:IRELAND ARMY COMMUNITY HOSPITAL
Other - Org Name:OCCUPATIONAL HLTH CLINIC-TACOM
Other - Org Type:Doing Business As
Authorized Official - Title/Position:UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:HORNBACK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-624-9870
Mailing Address - Street 1:289 IRELAND AVE
Mailing Address - Street 2:ATTN: TREASURERS OFFICE
Mailing Address - City:FORT KNOX
Mailing Address - State:KY
Mailing Address - Zip Code:40121-5111
Mailing Address - Country:US
Mailing Address - Phone:502-624-9274
Mailing Address - Fax:
Practice Address - Street 1:6501 E 11 MILE RD
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:MI
Practice Address - Zip Code:48397-5000
Practice Address - Country:US
Practice Address - Phone:502-624-9333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IRELAND ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-05-11
Last Update Date:2015-04-02
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
1891899274OtherPARENT FACILITY IRELAND ACH NPI
1891899274OtherPARENT FACILITY IRELAND ACH NPI
OTH000Medicare UPIN