Provider Demographics
NPI:1568668655
Name:WILLOW GROVE NAVAL HEALTH CLINIC
Entity Type:Organization
Organization Name:WILLOW GROVE NAVAL HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SUPERVISOR REVENUE COLLECTION
Authorized Official - Prefix:
Authorized Official - First Name:MARCIA
Authorized Official - Middle Name:
Authorized Official - Last Name:DICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-295-4934
Mailing Address - Street 1:8901 WISCONSIN AVE
Mailing Address - Street 2:PSC BOX 509 CODE 6300
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20889-0001
Mailing Address - Country:US
Mailing Address - Phone:301-295-4934
Mailing Address - Fax:301-295-1299
Practice Address - Street 1:609 INTRUDER DR
Practice Address - Street 2:BULDING 137
Practice Address - City:WILLOW GROVE
Practice Address - State:PA
Practice Address - Zip Code:19090-6001
Practice Address - Country:US
Practice Address - Phone:215-443-6357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL NAVAL MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-06-25
Last Update Date:2008-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1102XAmbulatory Health Care FacilitiesClinic/CenterMilitary Outpatient Operational (Transportable) Component