Provider Demographics
NPI:1457835456
Name:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MTF SUPPORT
Authorized Official - Prefix:
Authorized Official - First Name:ROSEMARY
Authorized Official - Middle Name:
Authorized Official - Last Name:GONZALEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:210-536-6096
Mailing Address - Street 1:110 RODMAN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCK ISLAND
Mailing Address - State:IL
Mailing Address - Zip Code:61299-0001
Mailing Address - Country:US
Mailing Address - Phone:502-624-9274
Mailing Address - Fax:309-782-0553
Practice Address - Street 1:BLDG 110 PHARM USA HEALTH CLINIC
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61299-0001
Practice Address - Country:US
Practice Address - Phone:309-782-0550
Practice Address - Fax:309-782-0553
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:BLANCHFIELD ARMY COMMUNITY HOSPITAL
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-17
Last Update Date:2018-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy