Provider Demographics
NPI:1417063488
Name:US ARMY
Entity Type:Organization
Organization Name:US ARMY
Other - Org Name:BAMBERG HEALTH CLINIC
Other - Org Type:Other Name
Authorized Official - Title/Position:PUBLIC HEALTH
Authorized Official - Prefix:
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:PREHN
Authorized Official - Suffix:
Authorized Official - Credentials:MAJ, AN, MSHS
Authorized Official - Phone:01149951-300-8619
Mailing Address - Street 1:USAMEDDAC WUERZBURG
Mailing Address - Street 2:ATTN: CREDENTIALS OFFICE, UNIT 26610
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09244
Mailing Address - Country:DE
Mailing Address - Phone:01149931-804-3616
Mailing Address - Fax:01149931-804-3241
Practice Address - Street 1:USAMEDDAC WUERZBURG
Practice Address - Street 2:BAMBERG HEALTH CLINIC, UNIT 27528
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09139
Practice Address - Country:DE
Practice Address - Phone:01149951-300-8619
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV48890261QC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV48890OtherREGISTERED NURSE
VAD000Medicare UPIN