Provider Demographics
NPI:1437236817
Name:BG CRAWFORD F SAMS ARMY HEALTH CLINIC
Entity Type:Organization
Organization Name:BG CRAWFORD F SAMS ARMY HEALTH CLINIC
Other - Org Name:AHC BG CRAWFORD SAMS-CAMP ZAMA
Other - Org Type:Other Name
Authorized Official - Title/Position:PRMC UBO MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:HUGH
Authorized Official - Middle Name:
Authorized Official - Last Name:KEEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:808-433-1016
Mailing Address - Street 1:MSA OFFICE
Mailing Address - Street 2:ATTN MCJA-PA
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96343-5011
Mailing Address - Country:US
Mailing Address - Phone:0118146-407-4693
Mailing Address - Fax:
Practice Address - Street 1:UNIT 45011
Practice Address - Street 2:JAPAN
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96338-5011
Practice Address - Country:US
Practice Address - Phone:0118146-407-4127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
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
VAD000Medicare UPIN
OTH000Medicare UPIN