Provider Demographics
NPI:1518374966
Name:47 MDSS-LAUGHLIN HOSPITAL
Entity Type:Organization
Organization Name:47 MDSS-LAUGHLIN HOSPITAL
Other - Org Name:DOD LAUGHLIN 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 1:47 MDSS-LAUGHLIN HOSPITAL
Mailing Address - Street 2:350 MITCHELL BLVD. RM 338
Mailing Address - City:LAUGHLIN AFB
Mailing Address - State:TX
Mailing Address - Zip Code:78843
Mailing Address - Country:US
Mailing Address - Phone:830-298-6451
Mailing Address - Fax:830-298-6511
Practice Address - Street 1:590 MITCHELL BLVD BLDG 375
Practice Address - Street 2:
Practice Address - City:LAUGHLIN AFB
Practice Address - State:TX
Practice Address - Zip Code:78843-5242
Practice Address - Country:US
Practice Address - Phone:830-298-6451
Practice Address - Fax:830-298-6511
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-17
Last Update Date:2016-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332000000XSuppliersMilitary/U.S. Coast Guard Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2146875OtherPK