Provider Demographics
NPI:1598064289
Name:MARINE CORPS LOGISTICS BASE ALBANY, GA
Entity Type:Organization
Organization Name:MARINE CORPS LOGISTICS BASE ALBANY, GA
Other - Org Name:MCLB ALBANY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASST. FIRE CHIEF OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:FOREST
Authorized Official - Middle Name:M
Authorized Official - Last Name:THOMAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-639-5610
Mailing Address - Street 1:814 RADFORD BLVD
Mailing Address - Street 2:SUITE 20346
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31704-1130
Mailing Address - Country:US
Mailing Address - Phone:229-639-5610
Mailing Address - Fax:
Practice Address - Street 1:814 RADFORD BLVD
Practice Address - Street 2:SUITE 20346
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31704-1130
Practice Address - Country:US
Practice Address - Phone:229-639-5610
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-21
Last Update Date:2014-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA993341600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes341600000XTransportation ServicesAmbulance