Provider Demographics
NPI:1558332080
Name:RAYMOND W BLISS ARMY HEALTH CENTER
Entity Type:Organization
Organization Name:RAYMOND W BLISS ARMY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICIENSED PRACTICAL NURSE
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:SUE
Authorized Official - Last Name:HALDORSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:520-533-2627
Mailing Address - Street 1:7935 E CONNOR RD
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85650-9081
Mailing Address - Country:US
Mailing Address - Phone:520-803-6793
Mailing Address - Fax:
Practice Address - Street 1:2240 WINROW RD
Practice Address - Street 2:
Practice Address - City:FT HUACHUCA
Practice Address - State:AZ
Practice Address - Zip Code:85613-5080
Practice Address - Country:US
Practice Address - Phone:520-533-2627
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-01
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLP028519261QM1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1100XAmbulatory Health Care FacilitiesClinic/CenterMilitary/U.S. Coast Guard Outpatient