Provider Demographics
NPI:1497160113
Name:KELLER ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:KELLER ARMY COMMUNITY HOSPITAL
Other - Org Name:DOD WEST PT EPHCY
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:KELLER ARMY COMMUNITY HOSPITAL
Mailing Address - Street 2:CO MCUD-RMD-UBOBUILDING 900
Mailing Address - City:WEST POINT
Mailing Address - State:NY
Mailing Address - Zip Code:10996-1197
Mailing Address - Country:US
Mailing Address - Phone:845-938-2271
Mailing Address - Fax:845-938-3168
Practice Address - Street 1:KELLER ARMY COMMUNITY HOSPITAL
Practice Address - Street 2:BUILDING 900 900 WASHINGTON ROAD
Practice Address - City:WEST POINT
Practice Address - State:NY
Practice Address - Zip Code:10996-1197
Practice Address - Country:US
Practice Address - Phone:845-938-2271
Practice Address - Fax:845-938-2261
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-23
Last Update Date:2016-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146369OtherPK