Provider Demographics
NPI:1467742627
Name:NAVY
Entity Type:Organization
Organization Name:NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMANDING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:COMMANDING
Authorized Official - Middle Name:
Authorized Official - Last Name:OFFICER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-433-5181
Mailing Address - Street 1:3828 BROADLEAF CT
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23453-2135
Mailing Address - Country:US
Mailing Address - Phone:757-285-1221
Mailing Address - Fax:
Practice Address - Street 1:USS GONZALEZ
Practice Address - Street 2:DDG 66
Practice Address - City:FPO
Practice Address - State:AE
Practice Address - Zip Code:09570-1284
Practice Address - Country:US
Practice Address - Phone:757-433-5181
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-08
Last Update Date:2011-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAT616367891710I1002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty