Provider Demographics
NPI:1518036722
Name:BRIAN ALLGOOD ARMY COMMUNITY HOSPITAL
Entity Type:Organization
Organization Name:BRIAN ALLGOOD ARMY COMMUNITY HOSPITAL
Other - Org Name:CAMP RED CLOUD CLINIC PHCY
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:UNIT 15244 BOX 316
Mailing Address - Street 2:ATTN UBO APO AP
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96205-5244
Mailing Address - Country:US
Mailing Address - Phone:210-221-8274
Mailing Address - Fax:
Practice Address - Street 1:BLDG 306
Practice Address - Street 2:
Practice Address - City:APO
Practice Address - State:AP
Practice Address - Zip Code:96258-0189
Practice Address - Country:US
Practice Address - Phone:315-737-7432
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-06
Last Update Date:2015-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2113986OtherPK
1760550636OtherPARENT FACILITY 121ST CSH/BAACH NPI
1437364502OtherFACILITY USAHC-CAMP RED CLOUD NPI