Provider Demographics
NPI:1437134822
Name:DARMSTADT HEALTH CLINIC
Entity Type:Organization
Organization Name:DARMSTADT HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS JEAN
Authorized Official - Middle Name:ABENOJA
Authorized Official - Last Name:CABA
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:314-348-6521
Mailing Address - Street 1:596 CS MAINT CO.
Mailing Address - Street 2:CMR 440 BOX 577
Mailing Address - City:APO, AE
Mailing Address - State:NY
Mailing Address - Zip Code:09175-0577
Mailing Address - Country:US
Mailing Address - Phone:314-348-6521
Mailing Address - Fax:314-348-7378
Practice Address - Street 1:ATTN; CREDENTIALS OFFICE
Practice Address - Street 2:CMR 442
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09042
Practice Address - Country:DE
Practice Address - Phone:314-348-6521
Practice Address - Fax:314-348-7378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIRN-46458261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIRN-46458OtherREGISTERED NURSE