Provider Demographics
NPI:1437496916
Name:NAVAL DIVING & SALVAGE TRAINING CENTER
Entity Type:Organization
Organization Name:NAVAL DIVING & SALVAGE TRAINING CENTER
Other - Org Name:NDSTC
Other - Org Type:Other Name
Authorized Official - Title/Position:DEEP SEA INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:ANGELO
Authorized Official - Middle Name:LUIS
Authorized Official - Last Name:SANCHEZ
Authorized Official - Suffix:JR
Authorized Official - Credentials:IDC
Authorized Official - Phone:850-235-5215
Mailing Address - Street 1:350 SOUTH CRAG ROAD
Mailing Address - Street 2:NAVAL DIVING & SALVAGE TRAINING CENTER
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32407-7018
Mailing Address - Country:US
Mailing Address - Phone:850-235-5218
Mailing Address - Fax:
Practice Address - Street 1:350 CRAG RD
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32407-7013
Practice Address - Country:US
Practice Address - Phone:850-235-5218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-03
Last Update Date:2013-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes286500000XHospitalsMilitary Hospital
No261QE0002XAmbulatory Health Care FacilitiesClinic/CenterEmergency Care
No2865M2000XHospitalsMilitary HospitalMilitary General Acute Care Hospital
No305S00000XManaged Care OrganizationsPoint of Service