Provider Demographics
NPI:1477940039
Name:UNTIED STATES NAVY
Entity Type:Organization
Organization Name:UNTIED STATES NAVY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:IDC
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRED
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:LEE
Authorized Official - Suffix:
Authorized Official - Credentials:IDC
Authorized Official - Phone:951-992-9627
Mailing Address - Street 1:BLDG 620305 8TH STREET
Mailing Address - Street 2:
Mailing Address - City:CAMP PENDELTON
Mailing Address - State:CA
Mailing Address - Zip Code:92055
Mailing Address - Country:US
Mailing Address - Phone:951-992-9627
Mailing Address - Fax:
Practice Address - Street 1:BLDG 620305 8TH STREET
Practice Address - Street 2:
Practice Address - City:CAMP PENDELTON
Practice Address - State:CA
Practice Address - Zip Code:92055
Practice Address - Country:US
Practice Address - Phone:951-992-9627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-22
Last Update Date:2015-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1710I1002XOther Service ProvidersMilitary Health Care ProviderIndependent Duty CorpsmanGroup - Single Specialty