Provider Demographics
NPI:1477564870
Name:U.S. NAVY
Entity Type:Organization
Organization Name:U.S. NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:INDEPENDENT DUTY CORPSMAN
Authorized Official - Prefix:
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:THEODORE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:IDC
Authorized Official - Phone:860-634-2876
Mailing Address - Street 1:PO BOX 159
Mailing Address - Street 2:BOX 159 NAVSUBASENLON
Mailing Address - City:GROTON
Mailing Address - State:CT
Mailing Address - Zip Code:06340-5159
Mailing Address - Country:US
Mailing Address - Phone:860-694-2876
Mailing Address - Fax:860-694-3696
Practice Address - Street 1:BOX 159 NAVSUBASENLON
Practice Address - Street 2:NAVAL UNDERSEA MEDICAL INSTITUTE
Practice Address - City:GROTON
Practice Address - State:CT
Practice Address - Zip Code:06340-5159
Practice Address - Country:US
Practice Address - Phone:860-694-2876
Practice Address - Fax:860-694-3696
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty