Provider Demographics
NPI:1447783378
Name:DEWITT ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:DEWITT ARMY COMMUNITY HOSPITAL
Other - Org Name:FAIRFAX HD PHCY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF DHA PASS
Authorized Official - Prefix:
Authorized Official - First Name:HECTOR
Authorized Official - Middle Name:
Authorized Official - Last Name:MORALES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6650
Mailing Address - Street 1:9501 FARRELL RD
Mailing Address - Street 2:STE GC 11
Mailing Address - City:FORT BELVOIR
Mailing Address - State:VA
Mailing Address - Zip Code:22060-5901
Mailing Address - Country:US
Mailing Address - Phone:301-295-4662
Mailing Address - Fax:
Practice Address - Street 1:10580 ARROWHEAD DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7301
Practice Address - Country:US
Practice Address - Phone:301-400-0912
Practice Address - Fax:301-295-4662
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-07
Last Update Date:2017-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2168778OtherPK