Provider Demographics
NPI: | 1518912823 |
---|---|
Name: | NAVAL HOSPITAL GUANTANAMO BAY |
Entity Type: | Organization |
Organization Name: | NAVAL HOSPITAL GUANTANAMO BAY |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | NAVY MEDICINE UBO PROGRAM MANAGER |
Authorized Official - Prefix: | MR |
Authorized Official - First Name: | WILLIAM |
Authorized Official - Middle Name: | MICHAEL |
Authorized Official - Last Name: | CONDON |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | |
Authorized Official - Phone: | 240-401-3643 |
Mailing Address - Street 1: | PSC 810 |
Mailing Address - Street 2: | |
Mailing Address - City: | FPO |
Mailing Address - State: | AE |
Mailing Address - Zip Code: | 09589 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 757-458-2998 |
Mailing Address - Fax: | 0115-399-2252 |
Practice Address - Street 1: | USNH COMMANDING OFFICE |
Practice Address - Street 2: | PATIENT ACCOUNTS |
Practice Address - City: | FPO |
Practice Address - State: | AE |
Practice Address - Zip Code: | 09589 |
Practice Address - Country: | US |
Practice Address - Phone: | 01153-997-2230 |
Practice Address - Fax: | 0115-399-2252 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | Yes |
Parent Organization LBN: | NAVAL HOSPITAL GUANTANAMO BAY |
Parent Organization TIN: | <UNAVAIL> |
Enumeration Date: | 2006-05-24 |
Last Update Date: | 2019-11-13 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 2865M2000X | Hospitals | Military Hospital | Military General Acute Care Hospital |